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Election Inspector Application

  1. Chesterfield Township Election Inspector Application
  2. Personal Information
  3. Emergency Contact Information
  4. Political Party Affiliation
  5. To be eligible, you MUST choose one political party*
  6. Are you a registered voter?*
  7. General Employment Questionnaire
  8. Have you ever been convicted of a felony or an election crime?*
  9. Do you have reliable transportation?*
  10. Are you willing to work at any polling location?*
  11. Educational & Employment History
  12. Do you have previous experience as an election inspector?*
  13. Certification & Signature
  14. A “known active advocate” of another political party is defined to mean a person who 1.) Is a delegate to the convention or an officer of another party; 2.) Is affiliated with another party through an elected or appointed government position; or 3.) Has made documented public statements specifically supporting by name another political party or its candidates in the same calendar year as the election at which the person will serve as an election inspector. “Documented public statements” means statements reported by the news media or written statement with a clear and unambiguous attribution to the applicant.
  15. I CERTIFY THAT I AM NOT A MEMBER OR A KNOWN ACTIVE ADVOCATE* OF A POLITICAL PARTY OTHER THAN THE PARTY IDENTIFIED ABOVE. I FURTHER CERTIFY THAT THE FOREGOING STATEMENTS ARE TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF.*
  16. By checking the box, I agree and certify that my printed signature is my signature and I agree to conduct this transaction electronically.*
  17. Type Legal Name
  18. Date of Signature
  19. ANY FALSE STATEMENTS ON THIS APPLICATION WILL DISQUALIFY THE APPLICANT
  20. Leave This Blank:

  21. This field is not part of the form submission.