BOE Poll Inspector Application

Schenectady County Board of Elections

Applicant Information	.	.
Last Name	First Name	Middle Initial
Street Address / Apt #	City, State	Zip Code
Home Phone Number	Cell Phone Number	EMail Address
Enter Your Date of Birth	Please Select Your Party Enrollment:

Applicant Questions:	.	.
Select Your Employment Status	Other Employment:
How far are you willing to travel on Election Day? 0-5 miles from home 5-10 miles from home ONLY at site where I vote Any poll site in my town Anywhere I am needed Preferred site(s):	Preferred Sites:
How will you get to the poll site on Election Day? My Car Someone will drive me Public Transp/Cab/Ride Share Walk Other:	Other Transportation:
Have you voted before? Yes No	If Yes, when was the last year you voted?
How often do you use the Internet? Daily Weekly Monthly Rarely Never	Can you speak, read, and write the English language? Yes No
Do you speak a language other than English? Yes No	If Yes, which language(s)?
How were you recruited as a poll worker?	If Other, please describe or provide Name.
Questions: Please call Schenectady County Board of Elections Phone: Laura or Loretta at (518) 377-2469 Email: pollworker@schenectadycounty.com