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VOTER TOTALS
Democrats:
Republicans:
NPA:
Others:
Total:

Election Worker Application Form

Thank you for your interest in becoming a Clay County election worker. To get started, please complete the following application and click SEND.

If you have any trouble with this form, please call our office at (904) 269-6350 for assistance.

First Name

Last Name

Preferred Name

Date of Birth

Home Phone Number

Cell Phone Number

Your Email Address

Street Address

City

State

Zip Code

I am currently registered to vote in Clay County

Yes

No

I am a State of Florida retiree.

Yes

No

If yes, date of retirement

I understand training is required before each class.

Yes

No

I have reviewed and am able to meet the requirements listed on the Election Worker Information Page (www.ClayElections.gov/Election-Workers-Volunteers/Election-Worker-Information)

Yes

No

Additional Comments