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Department of State
Pennsylvania Poll Worker Interest Form
Requirements
If you are interested in becoming a poll worker in Pennsylvania, complete and submit this form. Your information will be sent to the county election office where you live. Problems with this form? Call 1-877-VOTESPA (1-877-868-3772) or email
ra-voterreg@pa.gov
.
Required fields are marked with an asterisk.(*)
By completing this form, I confirm:
I am registered to vote at the address where I reside in Pennsylvania.(You will provide that address below.)
I am not a government official or employee. (You may check this box if you are a district judge, notary public, or member of the PA National Guard.)
I agree to attend any mandatory training.
I understand I may be required to work all day on election day, from before the polls open at 7:00 a.m. until after the polls close at 8:00 p.m.
Contact Information
First name
Last Name
Residential Address
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Zip Code
County of Residence
Adams
Allegheny
Armstrong
Beaver
Bedford
Berks
Blair
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Centre
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Statewide
Phone Type
Home
Mobile
Work
Primary e.g. XXX-XXX-XXXX
Phone Type
Home
Mobile
Work
Alternative e.g. XXX-XXX-XXXX
Email Address
Additional Information
Are you willing to travel within the county on election day?
Are you willing to travel within the county on election day?
No
Are you willing to travel within the county on election day?
Yes
If there are no vacancies now, may we contact you in the future?
If there are no vacancies now, may we contact you in the future?
No
If there are no vacancies now, may we contact you in the future?
Yes
Are you able to assist voters in a language other than English (including American Sign Language)?
Are you able to assist voters in a language other than English (including American Sign Language)?
No
Are you able to assist voters in a language other than English (including American Sign Language)?
Yes
If so, what language(s) do you speak, read, and write?
How fluent are you?
Basic
Intermediate
Advanced
Do you have any special skills or experience that are relevant for working at the polls?
Do you have any special skills or experience that are relevant for working at the polls?
No
Do you have any special skills or experience that are relevant for working at the polls?
Yes
If so, what skills do you have?
How did you find out about this opportunity?
Counties also need people to help manage election day duties. Are you willing to take on a high level of administrative responsibilities at the polling place? (For example, overseeing ballot chain of custody and reconciling vote totals at the end of the night.)
Counties also need people to help manage election day duties. Are you willing to take on a high level of administrative responsibilities at the polling place? (For example, overseeing ballot chain of custody and reconciling vote totals at the end of the night.)
No
Counties also need people to help manage election day duties. Are you willing to take on a high level of administrative responsibilities at the polling place? (For example, overseeing ballot chain of custody and reconciling vote totals at the end of the night.)
Yes
If so, what qualifies you for this type of position?
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