Name *

Address *

E-Mail *

Cell Phone *

Home Phone

Please select the election(s) you are available to work (please select all that apply) (hold the Ctrl key to make multiple selections) *Primary Election (June 28 2022)General Election (November 8 2022)

Class Preference: *OnlineIn-PersonNo Preference

If you Prefer In-Person classes, which time do you prefer? (please select all that apply) (hold the Ctrl key to make multiple selections)Morning (10 A.M.)Afternoon (2 P.M.)Evening (6 P.M.)No Preference

Are you comfortable with using I-pad/tablet technology? *YesNo

Do you read and speak Spanish fluently? *YesNo

Where are you willing to travel to work? (please select all that apply) (hold the Ctrl key to make multiple selections) *BrewsterCarmelCold SpringGarrisonKentMahopacPattersonPutnam LakePutnam Valley

Which position are you interested in working? (please select all that apply) (hold the Ctrl key to make multiple selections) *Polling Place CoordinatorVoting Machine InspectorSign-In Table ChairmanBallot Table ChairmanHelp Desk ChairmanSign-In Table InspectorBallot Table InspectorHelp Desk InspectorPrivacy Booth Clerk

Please provide any additional information about yourself that we should be aware of.