Fill - Free fillable Dear Citizen, Thank you for your interest in (City of Virginia Beach) PDF form

Dear Citizen,

Thank you for your interest in becoming an Officer of Election for the City of Virginia Beach.

Election Officials are placed at each of the city’s 100 polling locations. Each precinct will also have a

designated Chief Officer and Assistant Chief Officer. All Election Officials are given a great deal of

responsibility and trust in the election process. Officials work together to produce accurate election results,

provide for equal access to voting and assist individual voters that need help.

Compensation for working is $140.00. As a general requirement before working, you will attend a 3-hour

training workshop. Compensation for training is an additional $20.00. Processing payment may take up to six

weeks. Please note that if you attend training and then for some reason cannot work on Election Day,

we cannot pay you for the training session. In addition, we encourage you to attend an informal meeting

which is scheduled by your Chief Officer to organize the voting room prior to Election Day.

In order to confirm your appointment, you must carefully read the minimum requirements and essential

qualifications listed on the next page. An active email address is required in order to receive communications

and Election Day assignments. The Constitution of Virginia prohibits any person who holds any elective office

or is the deputy or employee of such elected official under the government of the United States, the

Commonwealth, or any Virginia county, city or town from serving as an Officer of Election. June Primary

elections are always tentative and require fewer Election Officials. We will not have confirmation of a June

Primary until April. A notice will be emailed prior to each election.

WHAT’S NEXT:

1) Complete and return the Election Official Appointment Form and Oath Your oath should be witnessed

by an Assistant Registrar from Voter Registration & Elections, a notary, Clerk or Deputy Clerk of the Circuit

Court. Your bank may also provide notary service. Bring identification such as driver’s license or military ID

or passport. Identification cannot be expired.

2) Complete I-9 Form in person at Voter Registration & Elections by presenting the acceptable document(s).

Returning workers do not need to complete this form again.

3) Complete Direct Deposit Form. Effective January 2021, all workers are encouraged to participate for

faster payment, eliminate lost check incidents/mail delay and save on payroll costs. Original or photocopy

of voided check is acceptable.

2021/2022 ELECTION DATES

Primary Election (if held) - June 8, 2021

General Election – November 2, 2021

Primary Election (if held) – June 14, 2022

General Election – November 8, 2022

Sincerely,

Lauralee M. Grim

Secretary

Virginia Beach Electoral Board

REQUIREMENTS AND ESSENTIAL QUALIFICATIONS

REQUIREMENTS

✓ Must be a registered voter of the Commonwealth of Virginia.

✓ You cannot hold elected office or be the employee of an elected official.

✓ Must attend the November Election training session.

✓ Be able to speak, read and write English.

✓ You must choose a political party to represent so each precinct is staffed appropriately.

ESSENTIAL QUALIFICATIONS

✓ You must not engage in any political conversation with voters and/or fellow Election Officials.

Communicate no bias or opinions on the election or candidates.

✓ You must have working knowledge of computers so that you can operate the Electronic Pollbooks to

check in voters in addition to the ability to complete online training when provided.

✓ You must have access to a computer/tablet/smart phone in order to receive email communication to

access and utilize our Easy Vote Web Portal.

✓ Must be able to follow directions, understand and operate the voting equipment once trained.

✓ Cannot conduct personal business within the polling location.

✓ Election Officials work for the Electoral Board and follow the guidelines and standards that lead to

exceptional customer service for our citizens in helping them be successful voters on Election Day.

✓ Election Officials must maintain a “good reputation” with colleagues and voters in the precinct. Be

courteous, professional and helpful to our voters.

✓ Must be willing to do what is necessary to maintain and secure voting environment.

✓ Wear appropriate attire (no blue jeans, workout clothes, t-shirts, or shorts).

PERFORMANCE STANDARDS

Chief Election Officers will observe the performance of assigned officers and should communicate their

concerns to provide the opportunity for corrective action. Certain circumstances may call for an Election Official

to be asked to leave or removed before duties are complete. Any questionable performance by an appointed

Election Official will be communicated to Voter Registration & Elections. Staff will review the situation and take

one of the following actions: reassign to another polling location, not assigned for future election, or not

recommend officer for reappointment. Election Officials may not be assigned to work future elections. Officers

not satisfied with action taken may appeal to the Electoral Board by emailing electiontraining@vbgov.com.

HOURS AND PLACEMENT

You must be available to work the entire Election Day. For security reasons, no exceptions are permitted.

Arrive at the polling location at 5:00 a.m. and remain there until the election results have been reported, all

paperwork has been completed and the polling place is returned to its original order (generally around 9:00

p.m.; for Presidential Election - 11:00 p.m.).

Whenever possible, you will be placed in your “voting” precinct. However, if there are no vacancies, you will be

placed at a nearby precinct not more than 10 miles from your registered address or placed on a waitlist until

there is availability. There is a possibility that we might ask you to change polling locations prior to Election Day

in order to meet staffing requirements.

CANCELLATION / LATE / NO SHOW POLICY

We understand that unexpected obligations, work commitments and illnesses can affect your schedule.

However, the sooner you notify Voter Registration & Elections, the better chance we have to find a

replacement. Late cancellations and No Shows have a significant impact on a polling location.

CANCELLATIONS: Two (2) cancellations may put you on a waitlist for future elections and will only be placed after verbal

confirmation of availability.

LATE: Arriving late not only reflects negatively on you but it also impacts the other Election Officials preparing to open the

polls. Late arrival to a training class or on Election Day may result in you being waitlisted or your Election Official

appointment being cancelled.

NO SHOW: If you fail to show up on Election Day, your Election Official appointment is automatically cancelled. Election

Officials are considered “no shows” when they fail to cancel.

2021/2022 OFFICER OF ELECTION APPOINTMENT FORM

Full Legal Name

Address

City/Zip

 Check here if this is a different address from your previous appointment

Home Phone

Cell Phone

Email Address REQUIRED

City of VB Employee ID # (if applicable)

COMPLETE ALL SECTIONS ON BOTH SIDES IN ORDER TO PROCESS YOUR ELECTION OFFICIAL APPOINTMENT

 I ACCEPT appointment as an Officer of Election and agree as follows.

 I UNDERSTAND that Officers of Election are required to attend the November Election

training session and that failure to attend any such training may render me ineligible to serve at

the election.

 I DO NOT hold any elected office, whether paid or unpaid, under the government of the

United States, the Commonwealth of Virginia, or any Virginia county, city or town; and

 I AM NOT the deputy or the employee of an elected official.

 I AFFIRM that I read and meet the requirements and essential qualifications for performing

Election Day assignments (refers to previous page).

Must choose ONLY one party:

This Board is required by Section 24.2-115 of the Code of Virginia to assure that both the Democratic and

Republican Parties have equal representation among the Officers of Election appointed. When you check either

box, please understand that you are not stating that you are a member of that particular party but are merely

agreeing to serve as that party’s representative on Election Day.

 I agree to represent the Democratic Party.

 I agree to represent the Republican Party.

AND select the following (if agreeable)



I also agree to represent either the Republican or Democratic Party when so needed at the

polls.

COMPLETE THIS SECTION IF YOU DO NOT WANT TO BE REAPPOINNTED AS AN OFFICER OF ELECTION.

PRINT YOUR NAME, MARK THE BOX AND RETURN TO VOTER REGISTRATION & ELECTIONS.

NAME _________________________________________________

 I DO NOT accept reappointment as an Officer of Election

AGREEMENT

ELECTION DATES

INITIAL next to the election dates you intend to participate.

______ June 8, 2021 (if held) Primary Election

______ November 2, 2021 General Election

______ June 14, 2022 (if held) Primary Election

______ November 8, 2022 General Election

DEDICATION & LOYALTY AGREEMENT

INITIAL that you have read, understand and agree to each one to the best of your ability.

______ Requirements and Essential Qualifications

______ Performance Standards

______ Hours and Placement

______ Cancellation/Late/No Show Policy

ELECTION OFFICIAL PAYMENT

______ INITIAL that you understand payment processing could take up to 6 weeks.

OATH OR AFFIRMATION

I, _______________________________, do SOLEMNLY SWEAR (or affirm) that I will support the Constitution

of the United States and the Constitution of the Commonwealth of Virginia, and that I will faithfully and

impartially discharge all the duties incumbent upon me as an Officer of Election of the City of Virginia Beach for

the term of two years beginning March 1, 2021 (or enter today’s date ______________, 20____,if appointed

after the term begins) according to the best of my ability (so help me God).

Signature (required)

WITNESS OPTIONS: Take the oath and sign it before one of the following: a Notary, an Assistant Registrar, Member

of the Electoral Board, the General Registrar, or the Clerk or Deputy Clerk of the Circuit Court. Any Assistant

Registrar at Voter Registration & Elections can witness your signature. Be sure to bring your identification.

NOTARY SEAL

Photographically

reproducible stamp

is required.

Signature of Notary or Person Administering Oath (required)

Title (i.e., Notary, Assistant Registrar, Clerk) Date

Voter Registration & Elections, 2449 Princess Anne Rd, Bldg. 14, P.O. Box 6247, Virginia Beach, VA 23456

Phone (757)385-8683 Fax (757)385-5632

Email electiontraining@vbgov.com

USCIS

Form I-9

OMB No. 1615-0047

Expires 10/31/2022

Employment Eligibility Verification

Department of Homeland Security

U.S. Citizenship and Immigration Services

Form I-9 10/21/2019

Page 1 of 3

►START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically,

during completion of this form. Employers are liable for errors in the completion of this form.

ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) an

employee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because the

documentation presented has a future expiration date may also constitute illegal discrimination.

Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no later

than the first day of employment, but not before accepting a job offer.)

Last Name (Family Name)

First Name (Given Name)

Middle Initial

Other Last Names Used (if any)

Address (Street Number and Name)

Apt. Number

City or Town

State

ZIP Code

Date of Birth (mm/dd/yyyy)

Employee's E-mail Address

Employee's Telephone Number

U.S. Social Security Number

1. A citizen of the United States

2. A noncitizen national of the United States (See instructions)

3. A lawful permanent resident

4. An alien authorized to work until

(See instructions)

(expiration date, if applicable, mm/dd/yyyy):

(Alien Registration Number/USCIS Number):

Some aliens may write "N/A" in the expiration date field.

I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in

connection with the completion of this form.

I attest, under penalty of perjury, that I am (check one of the following boxes):

Aliens authorized to work must provide only one of the following document numbers to complete Form I-9:

An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number.

1. Alien Registration Number/USCIS Number:

2. Form I-94 Admission Number:

3. Foreign Passport Number:

Country of Issuance:

QR Code - Section 1

Do Not Write In This Space

Signature of Employee

Today's Date (mm/dd/yyyy)

Preparer and/or Translator Certification (check one):

I did not use a preparer or translator. A preparer(s) and/or translator(s) assisted the employee in completing Section 1.

(Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.)

I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my

knowledge the information is true and correct.

Signature of Preparer or Translator

Today's Date (mm/dd/yyyy)

Last Name (Family Name)

First Name (Given Name)

Address (Street Number and Name)

City or Town

State

ZIP Code

Employer Completes Next Page

Form I-9 10/21/2019

Page 2 of 3

USCIS

Form I-9

OMB No. 1615-0047

Expires 10/31/2022

Employment Eligibility Verification

Department of Homeland Security

U.S. Citizenship and Immigration Services

Section 2. Employer or Authorized Representative Review and Verification

(Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first day of employment. You

must physically examine one document from List A OR a combination of one document from List B and one document from List C as listed on the "Lists

of Acceptable Documents.")

Last Name (Family Name) M.I.

First Name (Given Name)

Employee Info from Section 1

Citizenship/Immigration Status

List A

Identity and Employment Authorization

Identity

Employment Authorization

OR List B AND List C

Additional Information

QR Code - Sections 2 & 3

Do Not Write In This Space

Document Title

Issuing Authority

Document Number

Expiration Date (if any) (mm/dd/yyyy)

Document Title

Issuing Authority

Document Number

Expiration Date (if any) (mm/dd/yyyy)

Document Title

Issuing Authority

Document Number

Expiration Date (if any) (mm/dd/yyyy)

Document Title

Issuing Authority

Document Number

Expiration Date (if any) (mm/dd/yyyy)

Document Title

Issuing Authority

Document Number

Expiration Date (if any) (mm/dd/yyyy)

Certification: I attest, under penalty of perjury, that (1) I have examined the document(s) presented by the above-named employee,

(2) the above-listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge the

employee is authorized to work in the United States.

The employee's first day of employment (mm/dd/yyyy):

(See instructions for exemptions)

Today's Date (mm/dd/yyyy)

Signature of Employer or Authorized Representative

Title of Employer or Authorized Representative

Last Name of Employer or Authorized Representative

First Name of Employer or Authorized Representative

Employer's Business or Organization Name

Employer's Business or Organization Address (Street Number and Name)

City or Town

State

ZIP Code

Section 3. Reverification and Rehires (To be completed and signed by employer or authorized representative.)

A. New Name (if applicable)

Last Name (Family Name)

First Name (Given Name)

Middle Initial

B. Date of Rehire (if applicable)

Date (mm/dd/yyyy)

Document Title Document Number

Expiration Date (if any) (mm/dd/yyyy)

C. If the employee's previous grant of employment authorization has expired, provide the information for the document or receipt that establishes

continuing employment authorization in the space provided below.

I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if

the employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual.

Signature of Employer or Authorized Representative

Today's Date (mm/dd/yyyy)

Name of Employer or Authorized Representative

LISTS OF ACCEPTABLE DOCUMENTS

All documents must be UNEXPIRED

Employees may present one selection from List A

or a combination of one selection from List B and one selection from List C.

LIST A

2. Permanent Resident Card or Alien

Registration Receipt Card (Form I-551)

1. U.S. Passport or U.S. Passport Card

3. Foreign passport that contains a

temporary I-551 stamp or temporary

I-551 printed notation on a machine-

readable immigrant visa

4. Employment Authorization Document

that contains a photograph (Form

I-766)

5. For a nonimmigrant alien authorized

to work for a specific employer

because of his or her status:

Documents that Establish

Both Identity and

Employment Authorization

6. Passport from the Federated States

of Micronesia (FSM) or the Republic

of the Marshall Islands (RMI) with

Form I-94 or Form I-94A indicating

nonimmigrant admission under the

Compact of Free Association Between

the United States and the FSM or RMI

b. Form I-94 or Form I-94A that has

the following:

(1) The same name as the passport;

and

(2) An endorsement of the alien's

nonimmigrant status as long as

that period of endorsement has

not yet expired and the

proposed employment is not in

conflict with any restrictions or

limitations identified on the form.

a. Foreign passport; and

For persons under age 18 who are

unable to present a document

listed above:

1. Driver's license or ID card issued by a

State or outlying possession of the

United States provided it contains a

photograph or information such as

name, date of birth, gender, height, eye

color, and address

9. Driver's license issued by a Canadian

government authority

3. School ID card with a photograph

6. Military dependent's ID card

7. U.S. Coast Guard Merchant Mariner

Card

8. Native American tribal document

10. School record or report card

11. Clinic, doctor, or hospital record

12. Day-care or nursery school record

2. ID card issued by federal, state or local

government agencies or entities,

provided it contains a photograph or

information such as name, date of birth,

gender, height, eye color, and address

4. Voter's registration card

5. U.S. Military card or draft record

Documents that Establish

Identity

LIST B

OR AND

LIST C

7. Employment authorization

document issued by the

Department of Homeland Security

1. A Social Security Account Number

card, unless the card

includes one of

the following restrictions:

2. Certification of report of birth issued

by the Department of State (Forms

DS-1350, FS-545, FS-240)

3. Original or certified copy of birth

certificate issued by a State,

county, municipal authority, or

territory of the United States

bearing an official seal

4. Native American tribal document

6. Identification Card for Use of

Resident Citizen in the United

States (Form I-179)

Documents that Establish

Employment Authorization

5. U.S. Citizen ID Card (Form I-197)

(2) VALID FOR WORK ONLY WITH

INS AUTHORIZATION

(3) VALID FOR WORK ONLY WITH

DHS AUTHORIZATION

(1) NOT VALID FOR EMPLOYMENT

Page 3 of 3

Form I-9 10/21/2019

Examples of many of these documents appear in the Handbook for Employers (M-274).

Refer to the instructions for more information about acceptable receipts.

City of Virginia Beach

Finance Payroll Division

Employee Direct Deposit Authorization

2424 Courthouse Drive, Bldg 18, Room 209 Tel: 385-4301 Fax: 385-8943 FinancePayroll@vbgov.com

Revised: 06/28/12

Instructions

▪ For each checking account(s) attach a voided check or photocopy of voided check

▪ For each savings account(s) attach bank documentation for verification of bank routing and account number(s)

▪ A deposit slip is not acceptable documentation

▪ Provide at least two (2) weeks notice to the Finance Payroll Division prior to changing or closing any account(s)

▪ For one account, complete Section 1 ONLY. For two accounts, complete Section 1 and 2. For 3 accounts, complete

Section 1, 2 and 3. Return completed form to the Finance Payroll Division. (Maximum of three accounts.)

Voter Registration & Elections

Employee Name: (Last First MI)

Employee Number

Organization

SECTION 1) Deposit Net Pay

Effective Date

1/1/2021

Checking Savings

New Change Stop

Name of Financial Institution

Account Type (Select one)

Action Requested (Select one)

Routing Number

Account Number

SECTION 2) Deposit Fixed Amount

Effective Date

Checking Savings

New Change Stop

Name of Financial Institution

Account Type (Select one)

Action Requested (Select one)

Routing Number

Account Number

SECTION 3) Deposit Fixed Amount

Effective Date

Checking Savings

New Change Stop

Name of Financial Institution

Account Type (Select one)

Action Requested (Select one)

Routing Number

Account Number

I authorize the City and Financial Institution(s) listed above to deposit automatically to the indicated account(s) all

amounts payable to me by the City. If funds to which I am not entitled are deposited into my account(s), I authorize the

City to direct the Financial Institution to return said funds. This authority shall remain in effect until canceled in writing.

Employee Signature

Date

Daytime Phone Number

For Finance Payroll Office Use Only:

System Input:

Date:

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