	Atlantic County Government DEPARTMENT OF ADMINISTRATION Board of Elections

ADMINISTRATION

BOARD OF ELECTIONS

Board of Elections Office
Historic Court House Complex
5903 Main Street
Mays Landing, NJ 08330-1701
609.645.5867
609.645.5875 FAX

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Board of Elections Home Page

BOARD OF ELECTIONS - POLL WORKER Application

INSTRUCTIONS:

Please complete the following 2 PAGE application in as much detail as possible. Please note that mandatory fields are indicated with *.

Click on the SUBMIT at the bottom of the page when you have completed the application. After you click on the SUBMIT buttion you will be taken to a page that will provide you with the opportunity to review your application and make any revisions necessary. Once you've completed this process your Poll Worker Application will be submitted to the Board of Elections electronically. You may print out a copy for your records.

You will be contacted regarding the Training Class that you have been assigned to. At the training class you will be required to sign a printed version of this application.

PRINT AND MAIL FORM: You may also print and mail the form if you prefer. Click here to go to the Print and Mail form now.

NOTE: All Fields marked * are mandatory!

First Name:

Last Name:

Home Phone:

Age (if under 18):

Work/Day Phone:

Cell Phone:

Email Address:

Address:

Line 2:

City:

Zip:

Mailing Address**:

**If different from above

Line 2:

City:

Zip:

Party Affiliation:

Undeclared/Unaffiliated

Bilingual?

Yes

2nd Language:

Will Work Anywhere in County? Yes

If No, Where?

Availability of Car?

Yes

Please read the following:

The application, signed by the applicant under his or her oath, shall state: (1) the applicant's name and address; (2) the applicant's age, if the applicant is less than 18 years of age; (3) the political party to which he or she belongs or, if the applicant is not affiliated with a political party, the fact that the applicant is not so affiliated; and (4) that the applicant possesses the following qualifications: eyesight, with or without correction, sufficient to read nonpareil type; ability to read the English language readily; ability to add and subtract figures correctly; ability to write legibly with reasonable facility; reasonable knowledge of the duties to be performed by the applicant as an election officer under the election laws of this State; and health sufficient to discharge his or her duties as an election officer. N.J.S.A 19:6-2b

Applicant agrees that he/she will attend an additional training class if not assigned within 9 months of completing initial training class.

I have read the above.

I wish to work the following elections: (Check all that apply to you)

Elections:	Date:	Times:	Where:
Primary	1st Tuesday after 1st Monday in June	6 AM - 8 PM	Entire County
General	1st Tuesday after 1st Monday in November	6 AM - 8 PM	Entire County

Training Class Preferences: (Not a guarantee of assignment)

Times:

Morning - 10 AM

Daytime - 1 PM

Evening - 6 PM

Saturday - 10 AM

Locations:

Atlantic City - County Office Building Auditorium	Board of Election Office - Mays Landing
Northfield Warehouse

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