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Due to booklet configurationconstraints some blank pages are

necessary. This is not an error.

Are you interested in working at theas a Poll Worker?

Although the polling Locations are staffed for November 7General Election, we are beginning to prepare for the 200Election Cycle.

On election days in Palm Beach County, we staff our 53Polling Locations with approximately 4,300 Poll WorkenWould you like to be one of these helpful people? It takededication and efficiency; patience and friendliness are alsassets! Have we described you? If so, please complete thApplication below and mail it to us as soon as possible.

Once we have processed your Application, you will bcontacted (after January 1ST

) and asked to attend aOrientation Session prior to your working at the Polls.

Thank you!

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POLL WORKER APPLICATIONPlease PRINT clearly and answer all questions.

NAME:LAST FIRST MIDDLE

II ADDRESS:It STREET APT. # CITY ZIP CI

PHONE: DATE OF BIRTH

VOTER REGISTRATION #

SOCIAL SECURITY #

PRECINCT IN WHICH YOU ARE REGISTERED?

DO YOU HAVE YOUR OWN TRANSPORTATION?

SIGNATURE DATEL._._._._._._._._._._._._._._._._._._._._._._._._._._._._._.

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Detach the above Application and mail to:Theresa LePore

Supervisor of Elections, Palm Beach County301 N. Olive Avenue, Room 105

West Palm Beach, FL 33401-4795Phone: 561-355-2650

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