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Application to Work as an Election Worker

Name: ____________________________________________________________________________________

Address:__________________________________________________________________________________

City:______________________________________________________________________________________

State:__________________      Zip:_____________________

Home Telephone Number:_____________________________________________________________________

Work Telephone Number:_____________________________________________________________________

Cell Phone Number:__________________________________________________________________________

Do you have transportation? Yes________    No _________

Are you registered to vote? Yes_________   No _________

What party affiliation? _________________________Democrat _______________________Republican

Are you Bilingual?_______   If yes, what language?__________________________________________________

If you have worked as an election worker in the past, please indicate where and when you worked.______________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

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Complete & return to: Galveston County Clerk’s Office: P. O. Box 17253, Galveston, Texas 77553-7253