Pollworker Application

Perry County Board of Elections


200 S. Jackson Street

New Lexington, Ohio  43764

Phone:      (740) 342-2134

Fax:     (740) 342-4787


(Please Print or Type on Form)


Are you a registered voter in Perry County?     YES or NO








Party Affiliation:  __________Democrat     _________Republican     ______No Party


Have you ever worked as a Poll Worker?         YES or NO


If yes, When:______________________Where:__________________


Do you have computer experience:                  YES or NO


If yes, describe:_____________________________________________________________


Have you ever been convicted of a felony?     YES or NO


Do you have transportation on Election Day?    YES or NO


Are you able to lift up to 30 Lbs.?       YES or NO





Under penalty of perjury, I hereby swear or affirm that the above information is true and accurate. 

I understand that any active warrants or felony convictions on my criminal record will result in immediate termination as a Board of Elections election official.  No person who has been convicted of a felony, or any violation of election laws, shall serve as an election officer, pursuant to Ohio Revised Code 3501.27.