The City of Bloomington is recruiting qualified individuals to serve as Election Judges for the 2020 General Election.
If you are interested, please complete and return this form. Thank you.
Note: In the event you are selected to serve as an Election Judge, you must participate in training classes. If appointed,
official notification will be sent to you.
PERSONAL INFORMATION (Please print clearly)
Zip Code
Home Phone Cell Phone E-Mail (please provide)
Please see the attached letter from the City Clerk regarding COVID19.
Party Affiliation: DFL Republican Other or Not Affiliated with a Political Party
Legal Marijuana Now Grassroots-Legalize Cannabis
1. I am available to work: November 3
2. I am NOT available to work because:
3. Polling location preferences: (circle all that apply)
Any precinct Home precinct Any nearby precinct Specific precinct (32 choices)
4. Do you have a relative who is also applying to be an Election Judge in Bloomington at this time? Yes No
If yes, state their name and relationship
5. Print your first name as you would like it to appear on your name badge
6. Do you need a certification letter for your employer? Yes No
7. Are you an honorably discharged Veteran? Yes No
8. Are you interested in serving as a head judge or assistant judge in the future? Yes No
My preferred work hours (circle one answer) Note: Head Judges and Assistant Head Judges must work the full day.
Full day (6 am close) Half Day Morning (6 am 2:15 pm) Half Day Afternoon (2 pm close)
Must be a United States citizen
Must be an eligible voter in the State of Minnesota
Must be able to read, write and speak English clearly
Must not be the spouse, parent, stepparent, child, stepchild, sibling or stepsibling of any election judge serving in
the same precinct or of any candidate at that election
Must not be domiciled, either permanently or temporarily, with any candidate on the ballot at that election
Must not be a candidate at that election
_______(Initial on the line) I understand and meet these requirements
Have excellent math and organizational skills
Demonstrate attention to details
Support the lead election official in the polling place
Treat all voters fairly and respectfully
Handle stressful situations calmly
Able to rotate election judge duties
_______(Initial on the line) I understand and meet these requirements
The City of Bloomington is an Affirmative Action Employer proving equal employment opportunities to all; does not discriminate on the
basis of race, color, creed, religion, national origin, sex, sexual orientation, disability, age, marital status, status with regard to public
assistance, or membership or activity in a local commission. Individuals are evaluated and selected on the basis of merit.
Information requested that is defined by law as public may be released. Private data containing your contact information and party
affilition are classified as private data and only used by authorized city staff.
Please read the statements below and sign this application if you agree to the following:
To ensure fair and honest election results, if selected to serve as an election judge, I will adhere to the following:
Arrive at my polling place at the assigned time.
Be courteous and respectful to all voters regardless of race, physical challenge or efficiency in the English
Read the Election Judge Guide prior to Election Day and participate in the Election Judge Training.
Be responsible for the security of election equipment and supplies.
Complete all election documentation accurately and completely.
Support and report immediately to the Head Judge any malfunction or possible tampering of voting equipment,
unusual or suspicious behavior occurring in the polling room or any other event or occurrence that may
threaten the accurate gathering or sanctity of the vote.
Abstain from making personal and political opinion comments while serving as an election judge.
I certify that all information I have provided on this application is correct and that I have not omitted any
information. I understand that giving false information or omitting requested data may disqualify me from
further consideration as an election judge or result in dismissal, if discovered at a later date.
I authorize the City of Bloomington to verify the information I have provided in this application.
______________________________________________________________ ___________________
Signature Date
Please return the completed application to:
City Clerk’s Office
City of Bloomington
1800 West Old Shakopee Road
Bloomington MN 55431
or by e-mail to: kengberg@BloomingtonMN.gov
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