Poll Worker Application Form

Please fill in the following information:

 
Name
Home Address
Mailing Address
City
County
Zip Code
Politics
Home Phone
Social Security #
 
Date of Birth
Address and Phone Number if not at home during the day:
 
Street Address
Address (cont.)
City
Zip Code
Work Phone

Signature:_______________________________________Date:______________

Please sign and mail to:

WAYNE COUNTY BOARD OF ELECTIONS
200 VANOVER ST. SUITE 1
WOOSTER OH 44691-4849