Forms • Warner Robins, GA • CivicEngage

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Poll Worker Application

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First Name*

Last Name*

Address*

City

State

Zip Code

Home or Cell Phone*

Email

Date of Birth

Precinct

Language(s) Spoken

Are you employed*

Yes

No

Retired*

Yes

No

Student*

Yes

No

Are you willing to serve in any precinct*

Yes

No

* indicates required fields.