Fillable County Employee Poll Worker Application (San Bernadino County Registrar of Voters)

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County Employee Poll Worker Application (San Bernadino County Registrar of Voters)

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The County Employee Poll Worker Application (San Bernadino County Registrar of Voters) form is 1 page long and contains:

  • 0 signatures
  • 24 check-boxes
  • 32 other fields

Country of origin: US
File type: PDF

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1. Applicant Information (Please print clearly)
First Name
Last Name Birthday (mm/dd/yy)
Employee ID
Street Address
Unit/Apt #
City
State
Zip Code
Mailing Address (If different)
Unit/Apt #
City
State
Zip Code
Home Phone Number Cell Phone Number
Work Phone Number
Work Email Address
Are you registered to vote in the state of California? Yes
No
No
Home Email Address
Do you have access to a vehicle? Yes No
Are you available to work outside of your neighborhood? Yes
If Yes, how far? 5-10 miles 11-20 miles
21-30 mile 31-40 miles
2. Skills and Experience
(Please check all that apply)
Election Experience Professional Experience
Cantonese Khmer Tagalog
Hindi Korean Thai
Indonesian
Mandarin
Vietnamese
Japanese
Spanish
Clerk
Supervisor
Field Representative
Machine Technician
Other:_________________
Administration/Clerical
Customer Service
IT/Technical
Recruiting/Training
Supervisory
Other:________________________________________
3. Departmental Information
County Department Name
Immediate Supervisor Name
Immediate Supervisor Phone Number
By signing below, I tentatively approve this employee’s application to serve as a County Poll Worker (contingent on the successful completion of
training and selection to work) for the upcoming election.
Department Head Name (Print) Department Head Signature
Date
4. Compensation and Work Hours
Compensation:
As a San Bernardino County Employee you will receive your County pay while attending trainin g and working on
Election Day. This may include overtime and mileage reimbursement pursuant to your employee group’s Memorandum of
Understanding and other applicable ordinances, policies, and procedures. County employees will code all election
hours in EMACS and will not receive a separate stipend payment for completing Election Day assignments.
Work Hours:
Tuesday, September 14, 2021 (6:00 a.m. – approx. 9:30 p.m.).
County Employee
Poll Worker Application
Retur
n completed applications:
By Email:
By Fax:
Scan or take a picture of the application and email to pollworkers@sbcountyelections.com
(909) 387-2022
• By Mail or in Person: Registrar of Voters, 777 E. Rialto Avenue, San Bernardino, CA 92415
Individuals who are registered sex offenders cannot volunteer. For any questions, call the Registrar of Voters at (909) 387-8300.
5. Submission Instructions and Information
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Email
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Print
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County Employee Poll Worker Application (San Bernadino County Registrar of Voters)

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Completed 17 August 2021

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