Forms • Riverdale • CivicEngage

Poll Worker Application

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Office of the City Clerk Phone: 770-997-8989 Fax: 770-909-8854 Email:svaughan@riverdalega.gov 7200 Church Street Riverdale, Georgia 30274 www.riverdalega.gov City of Riverdale
Name:*
Residential Address: (Must be a resident of Clayton County to work as a Poll Worker in Clayton County)*
City:*
State:*
Zip Code:*
Mailing Address: (If different from above)
Home Telephone Number:*
Cell Telephone Number:*
Email Address:*
Social Security Number:*
Date of Birth: (MM/DD/YYYY)*
Presently Employed: *
If yes, Full time or Part time*
If yes, please give name of employer:*
Do you have computer experience?*
Have you ever served as a poll worker before?*
If yes, which precinct?*
What position would you have interest in working?*
Are you interested in learning how to work other positions at the polls?*
Are you interested in serving in the upcoming municipal election?*
Print your signature:*

* indicates required fields.