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