Form Center

2. Section 1: Personal Information
4. Full Name:*
6. Home Address:*
7. City:*
9. State:*
10. ZIP Code:*
12. Phone Number:*
13. Email Address:*
17. Section 2: Eligibility Confirmation
19. Are you a U.S. Citizen?*

    1. Yes

    1. No
21. Are you a resident of Georgia?*

    1. Yes

    1. No
23. Are you at least 16 years old?*

    1. Yes

    1. No
25. Are you able to read, write, and speak English?*

    1. Yes

    1. No
29. Section 3: Availability

    Please indicate your availability by selecting all applicable dates below. If you are available for all dates, please select all:

31. 1. Advance Voting (October 14 – October 31) | 9:00 a.m. – 5:00 p.m.
    2. Saturday, October 18 | 9:00 a.m. – 5:00 p.m.
    3. Saturday, October 25 | 9:00 a.m. – 5:00 p.m.
    4. Election Day – Tuesday, November 4 | 7:00 a.m. – 7:00 p.m.
35. Section 4: Experience & Interest
37. Have you served as a poll worker before?*

    1. Yes

    1. No
39. If yes, when and where?
41. Why are you interested in becoming a poll official?*
45. Section 5: Emergency Contact
47. Full Name:*
48. Relationship:*
50. Phone Number:*
54. Section 6: Acknowledgment

    By submitting this application, I certify that the information provided is accurate and complete. I understand that I must attend mandatory training if selected.

56. 1. I agree
58. Signature:*
59. Date:*
Leave This Blank:


61. 1. Receive an email copy of this form.
62. Email address

    This field is not part of the form submission.

63. Submit

* indicates a required field