APPLY TO BE A POLL WORKER: APPLICATION

 
*Last Name *First Name   M.I.
 
       
*Residential Address 
(where you are registered to vote)
*City   *State *Zip Code
   
 
Mailing Address (if different from above)E-Mail Address
 
*Primary Phone Number  Cell PhoneWork Phone
 
Are you a registered voter? Are you a high school student?
*Date of Birth 
 
Have you ever worked as a poll worker in Harris County 
If the answered is YES to the previous question, where did you work.
 
 
Would you be willing to travel to work at a polling place How far would you be willing to travel?
 
Are you able to speak one of these languages?
 
How did you hear about the Poll Worker Recruitment?
 
Any additional information you wish to include: