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Election Board Worker Application
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Please fill out and submit ONLY if interested in being a worker.
Address & City
Home Phone #
Cell Phone #
1. Do you have computer experience?
If yes, list programs you have worked with:
2. Are you willing to work at any polling place?
3. Do you need any accommodations to assist in fulfilling your duties?
Handicap Parking Space
4. Are you able to stand for long periods of time?
5. Have you ever been convicted of a misdemeanor or felony?
If yes, list when, where and nature of offense(s)
6. Do you know of anyone else who would be interested in working the elections?
Name, Address & Phone
Please list a name(s) and telephone number(s) of someone that we may contact in an emergency.
“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.”
Electronic Signature of Applicant
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