jefferson county elections - Jefferson County, Texas Elections

JEFFERSON COUNTY ELECTIONS
POLL WORKER APPLICATION
(APLICACION DE TRABAJADOR ELECTORAL)
Please provide the following information and return the completed application to the Jefferson County
Elections Department via mail, e-mail, fax, or hand delivery to:
(Por favor llene toda al informacion en la solicitud y devuelvala al departamento de Elecciones del Condado de
Jefferson via e-mail, fax, o entrega personal a:)
Naomi Doyle, Election Manager (Elección Sustantivo)
1001 N. Pearl St. – Physical Address (Dirección Física)
P.O. Box 1151 – Mailing Address (Dirección Postal)
Beaumont, TX 77701
409.835.8760 or 409.722.4637 (phone/teléfono) ■ 409.839.2394 (fax)
ndoyle@co.jefferson.tx.us
Name: _____________________________________________ Voter Reg. #: ____________________
(Nombre)
(# Reg, de Votante)
Address: ___________________________________________________________________________
(Direccion)
City (Ciudad) State (Estado) Zip Code (C, postal)
Precinct in which you reside: ________________
(Precinto donde Ud vive)
Contact Numbers: ______________________ ______________________ ______________________
(Num,Telefonico) Home (Casa)
Work (Trabajo)
Cell (Cellular)
E-Mail Address: ______________________________________________________________________
(Correo E-Mail)
Have you ever worked as a Poll Worker in Jefferson County?
(Ha trbajado Ud, como Trabajador Electoral en el Condado de Jefferson?)
___ Yes (Si)
___ No (No)
Do you speak any languages fluently other than English?
(Habla Ud, otro idioma aparte del Ingles?)
___ Yes (Si)
___ No (No)
If yes, please specify: __________________________________________________________
(De ser asi cual)
Would you accept an assignment at another precinct other than your own? ___ Yes (Si)
(Aceptaria Ud, ser asignado a otro precinto diferente al suyo?)
Do you have prior experience as an election official from another
jurisdiction?
(No)
(Tiene Ud, previa experiencia como un oficial electoral de otro Condado o
jurisdiccion?)
Do you have a political party affiliation?
(Esta Ud, afiliado a un partido politico?)
___ No (No)
___ Yes (Si)
___ Yes (Si)
___ No
___ No (No)
If yes, please specify: __________________________________________________________
(De ser asi cual)
Page (Pajina) 1 of 2
PLEASE COMPLETE BOTH SIDES. (POR FAVOR LLENE LOS DOS LADOS.)
JEFFERSON COUNTY ELECTIONS
Please list the area(s) of Jefferson County you would be willing to work:
(Haga una lista de areas donde estaria dispuesto a trabajar en el Condado de Jefferson:)
_____________________________________________________________________________________
_____________________________________________________________________________________
Please check any position(s) you would be willing to work.
(Marque los pestos que desea desempenar.)
___ Judge
(Juez)
___ Early Voting Clerk
(Secretario de Elecciones Adelantada)
___ Alternate Judge
(Juez Alterno)
___ Early Voting Ballot Board
(Junta de Votacion de Elceciones Adelantada)
___ Clerk
(Secretario)
___ Emergency Election Judge/Clerk
(Juez/Secretario de Elecciones de Emergencia)
Please check any election(s) you would be willing to work.
(Marque los pestos de Elecciones que desea desempenar.)
___ Primary Elections (March)
(Elecciones Primarias (Marzo))
___ Special Elections (May)
(Elecciones Especiales (Mayo))
___ Primary Run-Off Elections (April)
(Desempate de Elecciones Primarias (Abril))
___ General/Constitutional
Amendment Elections (November)
(General/Constitucion Enmienda Electoral (Noviembre))
___ Special Elections (November)
(Elecciones Especiales (Noviembre))
Please indicate any person(s) who you know that may be interested and willing to serve as a poll worker at
polling locations during Jefferson County elections.
(Si Ud, conoce a personas que estan interesadas y dispestas a server como Trabajadores(as) Electorales
Durante las Elecciones en el Condado de Jefferson anote sus Nombres.)
Name (Nombre)
Address (Direccion)
Telephone Number(Numero de Telefono)
_______________________________________________________________________________________
_______________________________________________________________________________________
Comments: (Comentarios:) ________________________________________________________________
_______________________________________________________________________________________
________________________________________________
Signature (Firma)
Date (Fecha)
Page (Pajina) 2 of 2
PLEASE COMPLETE BOTH SIDES. (POR FAVOR LLENE LOS DOS LADOS.)