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2. First Name*
3. Last Name*
5. Voter Registration Number*
6. Gender

   1. Male
   2. Female
7. Date of Birth
   Date of Birth
9. Address*
11. City*
12. State*
13. Zip Code*
15. Mailing Address (if different than above)
17. City
18. State
19. Zip Code
21. Precinct*
22. I am applying for the position of*

    1. Any position
    2. Chief Judge
    3. Judge
    4. Assistant
    5. One-Stop Voting worker
    6. Volunteer
    7. Other
24. Are you related to anyone currently working at your voting precinct?*

    1. Yes
    2. No
26. Check the boxes for all that is true*

    1. I am willing to work in a precinct other than my assigned precinct.
    2. I will be able to attend a 3-4 hour training session before each election.
    3. I have my own transportation to and from a polling place on Election Day.
    4. I have basic computer skills. (Internet, Email, Social Networking, ect.)
    5. I am able to lift 30 lbs.
    6. I am able to work from 6am to at least 8pm on Election Day.
    7. I understand I may be required to assist other election workers.
    8. I am currently a registered voter in Onslow County.
    9. I am currently over the age of 18.
28. Phone Number*
30. Email Address
32. Any additional information
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field