Elections Department
 

Miami-Dade County Elections Poll Worker Application


Contact Information*
Name
Date of Birth
Street Address
Apt #
City
State
Zip Code
Home Phone Number
Work Phone Number
Cellular Phone Number
Email Address
Voter Registration Number



Do you have any computer or technological experience?*
Yes (Please Specify) 
No


Do you speak any other languages fluently?*
Yes (Please Specify) 
No


Do you have access to reliable transportation?*
Yes
No


Are you a current Miami-Dade County employee?* 
If yes, obtain your supervisor’s approval to serve as a Poll Worker before submitting this application.
Yes (Name the Department) 
No


Would you accept an assignment to a precinct other than your own?*
Yes
No


How did you hear about the Poll Worker opportunity?*
Elections Outreach Event
Current Poll Worker (Name) 
County Employee (Name)
College or University (Please specify) 
High School (Please specify) 
Elections Website
Other Website (Please specify)
Radio Advertisement
Print or Newspaper Advertisement
Career Source
City/Municipality (Please specify) 
Other (Please specify) 



 
By checking this box, I am confirming that I can read, write and speak in English and that the answers above are accurate to the best of my knowledge and belief.



Accommodations for persons with disabilities
People who require assistance because of their disabilities in order to participate in the programs, activities or services of the Miami-Dade County Elections Department, may contact Humberto Villamil at 305-499-8417 or humvill@miamidade.gov. To request materials in accessible format, sign language interpreters, or other means of equally effective communication to participate in any program or meeting, please contact him five days in advance to initiate your request. TTY users may also call 711 (Florida Relay Service.)


 
*All Fields Required


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