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Election Board Worker Application

  1. Please fill out and submit ONLY if interested in being a worker.
  2. Address & City
  3. 1. Do you have computer experience?*
  4. 2. Are you willing to work at any polling place?*
  5. 3. Do you need any accommodations to assist in fulfilling your duties?
  6. Handicap Parking Space*
  7. Handicap Restroom*
  8. 4. Are you able to stand for long periods of time?*
  9. 5. Have you ever been convicted of a misdemeanor or felony?*
  10. Name, Address & Phone
  11. Please list a name(s) and telephone number(s) of someone that we may contact in an emergency.
  12. Please Read:
    “I swear or affirm that I am a citizen of the United States and a Kansas resident, that if convicted of a felony, I have had my civil rights restored. I have told the truth on this worksheet, and the information provided is complete and correct to the best of my knowledge. I understand that any incomplete, incorrect or false information furnished by me may void this application.”
  13. Leave This Blank:

  14. This field is not part of the form submission.