Election Inspector Application
City of Traverse City
ATTN: City Clerk
400 Boardman Ave
Traverse City, MI 49684
(p): 231-922-4480
(f): 231-922-4485
tcclerk@traversecitymi.gov
Revised: January 22, 2019
Name (First, M.I., Last)
Address
City State Zip Code
Social Security Number
Home Phone No.
Cell Phone No.
Registered in:
City
Township
Village
Precinct #
County Of: Length of Residence in County
Have you ever been convicted of a felony or election crime?
Yes No
Educational Background
Employment Background (Include
current or last place of employment
)
Past experience as an election inspector,
if any (include jurisdiction)
Do you have transportation?
Yes No
Will you work at any polling location?
Yes No
I CERTIFY THAT I am not a member or a known active advocate* of a political party other than the party identified above. I FURTHER
CERTIFY THAT the foregoing statements are true to the best of my knowledge and belief.
Today's Date:
* A "known active advocate" of another political party is defined to mean a person who 1) is a delegate to the convention or an officer
of another party, 2) is affiliated with another party through an elected or appointed government position or, 3) has made documented
public statements specifically supporting by name another political party or its candidates in the same calendar year as the election at
which the person will serve as an inspector. "Documented public statements" means statements reported by the news media or
written statements with a clear and unambiguous attribution to the applicant.
ANY FALSE STATEMENTS MADE ON THIS APPLICATION WILL DISQUALIFY THE APPLICANT.
Political Party Affiliation (Must choose one):
Republican
Democratic
Libertarian
U.S. Taxpayers
Green Party
Natural Law
E-mail
Date of Birth
Working Class
Race:
White Indian Black
Hispanic Asian
Marital Status:
Single Married
Sex:
Female MalePrefer not to answer
Prefer not to answer
Prefer not to answer
Signature:
click to sign
signature
click to edit
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