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2. Qualifications

   Have you reviewed the information about Indiana and St. Joseph County requirements for Election Workers?  If not, please check out our Election Worker Information page.

4. First Name*
5. Last Name*
6. Date of Birth*
   Date of Birth

   For voter verification.

8. Address*
10. City*
11. State*
12. Zip Code*
14. Mailing Address

    1. My mailing address is different than my residential address.
16. Mailing Address*
18. City*
19. State*
20. Zip Code*
22. Primary Phone Number*
23. Alternate Phone Number
24. Email Address*
26. Party Affiliation*
    -- Select One --DemocratRepublican

    The political parties provide workers to ensure bipartisanship.

28. Have your previously worked an Election?*

    1. Yes
    2. No

    (in St. Joseph County, IN)

29. Preferred Vote Center Location
31. What Position(s) are you interested in?*

    1. Inspector
    2. Judge
    3. Clerk
    4. Sheriff

    1. Absentee
    2. Central Count
    3. Tech
    4. No Preference

    You may check one or more.  Some positions are only available to a specific party affiliation to balance bipartisan teams.

33. Why be an Election Worker?*

    Briefly, let us know what got you interested in being an Election Worker.

34. Skills & Experience*

    Do you have any specific skills or experience that you believe would aid you in working the election?

Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field