Fillable Poll Worker Application

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Poll Worker Application

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The Poll Worker Application form is 1 page long and contains:

  • 0 signatures
  • 24 check-boxes
  • 25 other fields

Country of origin: OTHERS
File type: PDF

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Return completed applications:
By Email: Scan or take a picture of the application and email to pollworkers@sbcountyelections.com
By Fax: (909) 387-2022
By Mail or in Person: Registrar of Voters, 777 E. Rialto Avenue, San Bernardino, CA 92415
Individuals who are registered sex offenders cannot volunteer. For any questions, call the Registrar of Voters Office at (909) 387-8300
Do you have access to a vehicle? Yes No Are you registered to vote in the state of California? Yes No
2.
Skills and Experience
(Please check all that apply)
Election Experience
Professional Experience
Clerk
Administrative/Clerical
Cantonese
Khmer
Tagalog
Supervisor
Customer Service
Hindi
Korean
Thai
Field Representative
IT/Technical
Indonesian
Mandarin
Vietnamese
Machine Technician
Recruiting/Training
Japanese
Spanish
Other:__________________
Supervisory
Other:
______________________
3. Availability
Are you currently employed?
Yes No If Yes, list employer:
Are you available to work outside of your neighborhood? Yes No
If Yes, how far? 5-10 miles 11-20 miles 21-30 miles 31- 40 miles
Clerk: $100 per day.
Stipend for completing the entirety of all election assignments.
Assistant Supervisor: $135 per day.
Stipend for completing the entirety of all election assignments.
Supervisor: $175 per day.
Stipend for completing the entirety of all election assignments.
Training Class Stipend: $20 per 2-hour session.
Stipend issued with completion of Election Day assignment.
Bilingual Pay: $10 per day.
Stipend issued to poll workers who successfully complete bilingual testing and are assigned by
the Registrar of Voters Office to a bilingual position.
Work Hours: Saturday, October 31
st
, 2020 – Monday, November 2
nd
, 2020 (9:00 a.m. – 7:00 p.m.).
Tuesday, November 3
rd
, 2020 (6:00 a.m. – approx. 9:30 p.m.).
*All poll workers are required to report to their assigned polling place at the start of each day and work the entire shift.
3. Availability
1. Applicant Information (Please print clearly)
Poll Worker Application
Home Phone Number
Cell Phone Number
Email Address
Mailing Address (If different)
Unit/Apt #
City
State
Zip Code
Street Address
Unit/Apt #
City
State
Zip Code
First Name
Last Name
Birthday (mm/dd/yy)
4. Compensation and Work Hours
5. Submission Instructions and Information
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Poll Worker Application

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Completed 21 September 2020

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