Form Center

2. Name
3. Email Address
5. Address
7. City
8. State
9. Zip Code
11. Primary Phone Number
12. Other Phone Number
14. Have you been an Election Worker previously?

    1. Yes
    2. No
16. Are you a qualified elector in Dane County?

    1. Yes
    2. No
    3. High School Poll Worker

    (Registered to vote or qualified to be registered to vote in a municipality in Dane County)

18. Available Positions

    1. Electronic Poll Book (check in voters, register voters)
    2. Ballot Table (take ballot number from voter and give them a ballot)
    3. Absentee Ballot Processor (process absentee ballots)
    4. Chief Inspector (requires additional training)

    Please place a check in the box for each position you would be willing to work (can check more than one).

20. Preferred Shift

    1. AM (6:45 AM - 1:00 PM)
    2. PM (1:00 PM - 9:00 PM)
    3. Either Shift
    4. All Day

22. Every effort is made to assign Election Workers to their desired jobs. However, this cannot be guaranteed, and assignments are subject to change on an as needed basis.

24. Applicant Signature
25. Date
27. Thank you for your interest in being an Election Worker.

29. If you have any questions, please contact:

    Renee:  renee@cross-plains.wi.us

    Bobbi: bobbi@cross-plains.wi.us

    or call us at: 608-798-3241

Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field