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Poll Worker Application

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This form has been modified since it was saved. Please review all fields before submitting.

First Name*
Last Name*
Preferred Name
Date of Birth*
Date of Birth
Last 4 of Social Security #*
Mailing Address*
City*
State*
Zip Code*
Residential Address (If different from above)
City
State
Zip Code
Email Address*
Phone Number*
Phone*
1. Home Phone
1. Cell Phone
Are you employed?*
1. Yes
1. No
If yes,
1. Full-Time
1. Part-Time
Are you able to get the necessary time off?
1. Yes
1. No
Are you a registered voter in Camden County?*
1. Yes
1. No
Have you ever been a poll worker?*
1. Yes
1. No
If yes, where?
Are you able to work at any precinct in the county?*
1. Yes
1. No
Which precinct(s) have you worked at?
At what precinct do you vote?*
Do you understand you will have to work at least a 14-hour day, on a Tuesday?*
1. Yes
1. No
What Election positions are you interested in working?
Election Day Worker (Tuesday)
1. Clerk
1. Co-Manager
1. Manager
Advance Voting Worker (Monday-Friday)
1. Yes
1. No
Early Voting Worker (Saturday)
1. Yes
1. No
By typing your name below and submitting this online form you are stating, “I am at least 16 years of age, able to read, write and speak the English language. I do not hold a public office, nor am I related to a candidate whose name will appear on the ballot. I am a United States citizen.”
Name*
Today's Date*
Today's Date
Please note that contact information provided to a government agency may be subject to public release as required by Georgia’s Open Records Law.
Printable Version of Poll Worker Application
Official Poll Worker Application (PDF)
Direct Deposit Form
Direct Deposit Form (PDF)
Employee's Withholding Certificate Form W-4
Employee's Withholding Certificate Form W-4 (PDF)
State of Georgia Form G-4
State of Georgia Form G-4 (PDF)
Form I-9 Instructions
Form I-9 Instructions (PDF)
Form I-9
Form I-9 (PDF)