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2. All blanks and boxes must be completed. Use N/A where appropriate.
4. First Name
5. Last Name
7. Telephone Number
8. Email Address *
10. Address
12. City
13. State
14. Zip Code
16. Date of Birth
    Date of Birth
18. Are you Registered To Vote in Oakland County?

    1. Yes
    2. No
19. Political Party Affiliation?

    1. Republican
    2. Democrat

    To be eligible for appointment you must check one.
21. Have you ever been convicted of a felony or election crime?

    1. Yes
    2. No
23. Employment Background:
    Includes current or last place of employment and type of work preformed.
25. Past Experience as an Election Inspector, if any:
    Include name of jurisdiction.
27. Do you have transportation?

    1. Yes
    2. No
28. Will you work at any polling place?

    1. Yes
    2. No
30. 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.

    1. Yes
    2. No

    *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 statements with a clear and unambiguous attribution to the applicant.
32. Any false statements on this application will disqualify the applicant!
Leave This Blank:


34. Submit

* indicates a required field