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Address City Zip Code
Poll Worker Application
First Name Middle Last Name
Mailing Adress (If different than above)
Home Telephone # Cell Phone #
Signature
Date
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Are you a Registered Voter? £ Yes £ No
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Have you ever served as an Election Board Worker? £ Yes £ No
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Would you accept assignment to another town in your county? £ Yes £ No
(if you checked yes, please list below what town(s) you prefer)
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State the Political Party to which you belong?
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Do you speak any other language in addition to English? £ Yes £ No
If so what language(s)?
Please mail or fax completed form to:
Gloucester County Board of Elections
P.O. Box 352
Woodbury, NJ 08096
Tel: 856-384-4500
Fax: 856-251-1647