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Poll Worker Application
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Office of the City Clerk
Phone: 770-997-8989
Fax: 770-909-8854
Email:svaughan@riverdalega.gov
7200 Church Street
Riverdale, Georgia 30274
www.riverdalega.gov
City of Riverdale
Name:
*
Residential Address: (Must be a resident of Clayton County to work as a Poll Worker in Clayton County)
*
City:
*
State:
*
Zip Code:
*
Mailing Address: (If different from above)
Home Telephone Number:
*
Cell Telephone Number:
*
Email Address:
*
Social Security Number:
*
Date of Birth: (MM/DD/YYYY)
*
Presently Employed:
*
Yes
No
If yes, Full time or Part time
*
Full Time
Part Time
If yes, please give name of employer:
*
Do you have computer experience?
*
Yes
No
Have you ever served as a poll worker before?
*
Yes
No
If yes, which precinct?
*
What position would you have interest in working?
*
Are you interested in learning how to work other positions at the polls?
*
Yes
No
Are you interested in serving in the upcoming municipal election?
*
Yes
No
Print your signature:
*
* indicates required fields.
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