Poll Worker Application
  1. Thank you for your interest in being a poll worker for Clark County. Poll workers are selected by the party chairpersons of the respective political party. We will forward your request to the appropriate party for their consideration.

    Please fill out this form if you are a registered voter and resident of Clark County and are willing to be placed on a list of potential poll workers for the November 3rd, 2020 General Election.

    (If you are not currently registered to vote, please visit www.indianavoters.com to do so before applying for this position.)

    * Denotes a required field
  2. NAME
  3. Name Prefix(*)
    Please select a prefix.
  4. First Name(*)
    Please provide a first name
  5. Middle Name
    Invalid Input
  6. Last Name(*)
    Please provide a last name.
  7. Suffix
    Invalid Input
  8. Date of Birth(*)
    / / Please select your date of birth.
  9. HOME ADDRESS
  10. Street:(*)
    Please provide your street address.
  11. City:(*)
    Please provide your city.
  12. Zip Code:(*)
    Please provide a zip code.
  13. CONTACT INFORMATION
  14. Daytime Phone:(*)
    Please provide a valid phone number.
  15. Mobile Phone:
    Please provide a valid phone number.
  16. Email Address:(*)
    Please provide a valid email address.
  17. OTHER INFORMATION
  18. For which position are you applying?(*)
    Please make a selection.
  19. Have you ever worked as a poll worker in Clark County?(*)

    Please make a selection.
  20. What is your political party affiliation?(*)
    Please make a selection.
  21. Are you an employee of Clark County?(*)

    Please make a selection.
  22. If you are applying to be an Inspector, do you have access to reliable transportation to pick-up and return election materials?(*)

    Please make a selection.
  23. Are you willing to work in a precinct away from your neighborhood?(*)

    Please make a selection.
  24. Are you willing to use your personal mobile phone on Election Day?

    Invalid Input
  25. Do you have text messaging capability on your mobile phone?

    Invalid Input
  26. How did you hear about becoming a poll worker?(*)
    Please make a selection.
  27. When would you prefer to attend training?(*)
    Please make a selection.
  28. What time of day would you prefer to attend training?(*)
    Please make a selection.
  29. By checking the box below, I certify that I am a currently registered voter in Clark County, and my answers are correct to the best of my knowledge and belief:
  30. I Agree:(*)
    You must select the check box in order to continue.
  31. Captcha
    Invalid Input

For Additional Information Please Contact the
Clark County Voter Registration Office

Susan Popp, Clark County ClerkSusan Popp, Clark County Clerk
Clark County Voter Registration
501 E. Court Avenue, Room 139
Jeffersonville, IN 47130
812.285.6329 TEL
812.280.5652 FAX
vote@clarkcountyvoters.com