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2. Online Poll Worker Application For The 2023 General Election
4. Please note any question with a red * requires an answer. You will find that almost every question will require an answer. You will not be able to submit this form until all fields with the red * are completed.
6. Contact Information
8. First Name*
   Please use your legal name
9. Last Name*
   Please use your legal name
11. Street Address*
    Please provide the street address where you legally reside
13. City*
14. State*
15. Zip*
17. Home Phone Number*
18. Cell Phone Number*
19. Email Address*
21. What Is The Best Way To Contact You?*

    1. At The Email Address Above
    2. At The Home Number Listed Above
    3. At The Cell Phone Number Listed Above
23. What Is The Best Time To Contact You At That Phone Number?

    1. Weekday Mornings

    1. Week Day Afternoons

    1. Anytime
25. Poll Worker Qualifying Information
27. Are You A US Citizen?*

    1. Yes
    2. No
28. Do You Live In Porter County*

    1. Yes
    2. No
29. Are You Registered To Vote?*

    1. Yes
    2. No
31. Are you the treasurer or chairman of the committee for a candidate on the ballot?*

    1. Yes

    1. No
33. Are a you a candidate on the ballot, or a relative by birth, marriage or adoption of a candidate on the ballot?*

    1. Yes

    1. No
35. What Is Your Date Of Birth?*
    What Is Your Date Of Birth?
37. What Is Your Political Party Affiliation?*

    1. Democrat

    1. Republican
39. Poll Worker Experience
41. Which Position Are You MOST Interested In Working?*

    1. Inspector

    1. Judge

    1. Clerk

    1. Election Night Worker
43. What Position Are You MOST Interested In Working?*

    1. Judge

    1. Clerk

    1. Election Night Worker
45. Would You Accept Another Position?*

    1. Yes

    1. No
47. In What Township Would You Prefer To Work In?*

    1. Boone Township
    2. Center Township
    3. Jackson Township
    4. Liberty Township

    1. Morgan Township
    2. Pine Township
    3. Pleasant Township
    4. Portage Township

    1. Porter Township
    2. Union Township
    3. Washington Township
    4. Westchester Township
49. If There Are No Positions Open At Your Preferred Township, Would You Consider A Different Location?*

    1. Yes

    1. No
51. Have You Served As A Poll Worker Before?*

    1. Yes

    1. No
53. In Which Previous Elections Did You Serve As A Poll Worker*

    Check All That May Apply

    1. 2023 Primary Election
    2. 2022 General Election
    3. 2020 Primary Election

    1. 2020 General Election
    2. 2019 Primary Election

    1. 2019 General Election
    2. Elections Before 2019
55. In What Position(s) Did You Work?*

    Check All That Apply

    1. Inspector

    1. Judge

    1. Clerk

    1. Election Night Worker
57. Disclosures
59. The Chairs of the two major political parties have until October 18th to appoint poll workers. After October 18th, the Elections & Registration office will fill any vacancies. You MAY INCREASE YOUR CHANCE of being appointed as a poll worker if you allow us to forward your application to the Chair of the political party you have declared in this application form. May we forward your application to the Chair of the political party you have declared?*

    1. Yes

    1. No
61. I hereby authorize the Elections & Registration Office to forward my application information to the Chair of the political party that I have declared in this application, and authorize a representative of the Party Chair to contact me about being a poll worker.*

    1. I understand & agree.
63. Your application will be held by the Elections Office and your application will be considered if there are vacancies after the Party Chairs submit their poll worker assignments. Until the Party Chairs turn in their lists of Poll Worker appointments on October 18th, we will not know how many Poll Worker vacancies will need to be filled, and you may not be contacted until after October 18th if you are selected to be a Poll Worker.*

    1. I Understand & Agree
65. This online form is ONLY an application to become a Poll Worker. Your approval to work at the polls is not guaranteed until you receive a confirmation from the Elections & Registration Office*

    1. I Understand & Agree
67. If you are selected as a Poll Worker, you MUST attend a required training course.*

    1. I Understand & Agree
69. You are almost done! Please click on "Submit" below and you will be directed to a Form Submission Confirmation Page. If you are not directed to the Form Submission Confirmation Page, then you have probably missed providing required information on this form. Please scroll up to see any highlighted fields where an answer is required, then click on "Submit" again.
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71. 1. Receive an email copy of this form.
72. Email address

    This field is not part of the form submission.

73. Submit

* indicates a required field