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
NAME
Name Prefix(*)
Mr. Ms. Mrs. Miss Please select a prefix.
First Name(*)
Please provide a first name
Middle Name
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Last Name(*)
Please provide a last name.
Suffix
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Date of Birth(*)
Month 01 02 03 04 05 06 07 08 09 10 11 12 / Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / Year 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Please select your date of birth.
HOME ADDRESS
Street:(*)
Please provide your street address.
City:(*)
Please provide your city.
Zip Code:(*)
Please provide a zip code.
CONTACT INFORMATION
Daytime Phone:(*)
Please provide a valid phone number.
Mobile Phone:
Please provide a valid phone number.
Email Address:(*)
Please provide a valid email address.
OTHER INFORMATION
For which position are you applying?(*)
Inspector Judge Clerk Any Please make a selection.
Have you ever worked as a poll worker in Clark County?(*)
YES NO Please make a selection.
What is your political party affiliation?(*)
Democrat Republican Please make a selection.
Are you an employee of Clark County?(*)
YES NO Please make a selection.
If you are applying to be an Inspector, do you have access to reliable transportation to pick-up and return election materials?(*)
YES NO Please make a selection.
Are you willing to work in a precinct away from your neighborhood?(*)
YES NO Please make a selection.
Are you willing to use your personal mobile phone on Election Day?
YES NO Invalid Input
Do you have text messaging capability on your mobile phone?
YES NO Invalid Input
How did you hear about becoming a poll worker?(*)
Facebook Twitter Voter Registration Website Other Please make a selection.
When would you prefer to attend training?(*)
Monday - Friday Saturday Any Day Please make a selection.
What time of day would you prefer to attend training?(*)
Morning Afternoon Evening Any Time Please make a selection.
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:
I Agree:(*)
You must select the check box in order to continue.
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