Poll Worker Interest Form

2. Name

3. Email Address

5. Address

7. City

8. State

9. Zip Code

11. Phone Number

12. Fax Number

14. Are you a registered voter of Luzerne County?*

    1. Yes, I am a registered voter of Luzerne County

    Check this box ONLY if you are a registered voter of Luzerne County.

15. Are you 18 years of age or older?*

    1. Yes, I am at least 18 years of age

    Check this box ONLY if you are at least 18 years of age?

16. I will attend a mandatory Poll Worker training session and understand I will not receive compensation for this training.*

    1. I agree to attend the Poll Worker training session

    By checking this box, you agree to attend a mandatory Poll Worker training session and understand that you will not receive compensation for this training.

Leave This Blank:


18. 1. Receive an email copy of this form.
19. Email address

    This field is not part of the form submission.

20. Submit Submit and Print

* indicates a required field