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Date of Application
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Address
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Phone Number
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Email Address
Party Affliliation
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Position preference: Please check all that apply.
Absentee Ballot Counter
Assistant Registrar
Ballot Clerk
Demonstrator
Early Voting Ballot Box Attendant
Early Voting CVRS Worker
Moderator
Official Checker
Supervised Voting Worker
Tabulator Tender
Have you ever worked at a polling location?
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If yes, please list the location(s), position, and dates
Emergency Contact
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