You’re offline. This is a read only version of the page.
Skip to main content
Admin Dashboard
Toggle navigation
Home
EBR
EBR
DOBS
DLI
DOS
PID
DOR
Admin
Sign in
An Official
Pennsylvania
Government Website
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
*
*
City
*
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Outside of United States
Zip Code
*
*
County of Residence
*
Adams
Allegheny
Armstrong
Beaver
Bedford
Berks
Blair
Bradford
Bucks
Butler
Cambria
Carbon
Centre
Chester
Clarion
Clearfield
Clinton
Columbia
Crawford
Cumberland
Dauphin
Delaware
Elk
Erie
Fayette
Forest
Franklin
Fulton
Greene
Huntingdon
Indiana
Jefferson
Juniata
Lackawanna
Lancaster
Lawrence
Lebanon
Lehigh
Luzerne
Lycoming
McKean
Mercer
Mifflin
Monroe
Montgomery
Montour
Northampton
Northumberland
Perry
Philadelphia
Pike
Potter
Schuylkill
Snyder
Somerset
Sullivan
Susquehanna
Tioga
Union
Venango
Warren
Washington
Wayne
Westmoreland
Wyoming
York
Cameron
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?
*
Generate a new image
Play the audio code
Enter the code from the image
ACCESSIBILITY
PRIVACY & DISCLAIMERS
TRANSLATION DISCLAIMER
SECURITY
Copyright ©
2024
Commonwealth of Pennsylvania. All rights reserved.
