High School Student Election Judge (Poll Worker) Application

High School Student Election Judge (Poll Worker) Application

This form must be completed if you would like to work during the 2024 Election cycle. Background authorization forms and payroll information will be sent via DocuSign within 7 days of this form being submitted.

Election Dates in 2024:

Tuesday, November 5 (General)

2024 Pay Rates:

High School Student Election Judge - $16.32
Election Judge - $16.32
Election Captain - $17.01

Training Information:

All judges are required to complete a minimum of 2 hours of training to work on Election Day. Training will be conducted in a hybrid format. Basic training can be completed online or at an in-person session. More information about training will be sent after background checks are completed.

Equal Opportunity Employer:

We welcome you as an applicant for employment with the City of Golden Valley. It is the City of Golden Valley’s policy to provide equal opportunity in employment. The City will not discriminate on the basis of race, color, creed, age, religion, national origin, marital status, disability, sex, sexual orientation, familial status, status with regard to public assistance, local human rights commission activity or any other basis protected by law.

Applicant Data Practices Advisory:

Please refer to the Applicant Data Practices Advisory for information regarding what is considered public and private information as an applicant, and if you are selected for the position, as an employee.

Thank you for serving your community!

Election Judge Information

First Name*

Middle Name*

Type N/A if not applicable

Last Name*

Email Address*

How did you hear about this opportunity?

Check all that apply

Select or enter value

State of Minnesota Requirements to Serve as a High School Student Election Judge:

Must be a United States citizen
Must be a resident of Hennepin County or one of the following counties – Anoka, Carver, Dakota, Ramsey, Scott, Sherburne, Wright.
Must be 16 years of age or older on the day of the election.
Must be able to read, write and speak English.
Must have permission from my parents.
Must have permission from my high school and be in good academic standing (if school is in session on Election Day).
Must not be the spouse, parent, stepparent, child, stepchild, sibling or stepsibling of any election judge serving in the same precinct or of any candidate at that election
Must not live with, either permanently or temporarily, with any candidate on the ballot at that election

By checking this box I am confirming that I meet the above requirements to serve as a High School Student Election Judge.*

Parent/Guardian and School Contact Info

Provide the email address of your parent or guardian*

We need to be able to contact them for their permission for you to work as an election judge

Is your school in session on Election Day, November 5, 2024?*

Select

Please provide the name and email address for the main office of your school

We need to be able to receive their permission and notify them of the hours you will be working on Election Day.

Additional Contact and Background Information

Staff will need to verify your identity and then send a form to you in DocuSign so that we can gather your signature prior to running your background check. This information is needed to pre-populate the form before it is emailed to you.

Street Address*

City*

Zip Code*

Best Phone # to Reach You At*

Phone

Date of Birth*

Other Names Previously Used (type N/A if not applicable)*

Besides the name provided at the top of this form - please provide any other names that you have previously used. (maiden name, names from previous marriages, nicknames that have been used on official documents, etc.)

Election Day Information

What hours are you available to work on November 5?*

Check all that apply

Select

What is your 1st Choice of precinct to work at on Election Day?*

Select

What other precincts are you available to work at on Election Day?*

Check all that apply

Please note: We always do our best to accommodate everybody's first choice; however, we do need to maintain adequate staffing levels at all precincts across the city.

Select

Family Member(s) Also Applying to Work in Golden Valley

If you have a family member that will be working in a different Golden Valley precinct on Election Day, please provide their name below.

Reminder: This includes your spouse, parent, stepparent, child, stepchild, sibling or stepsibling.

Additional Opportunities

Would you like to receive additional training for a specialized position on Election Day?

Check all that apply

Select or enter value

What other languages do you speak fluently?

Please very briefly explain the type of equipment and technology that you are proficient in so that we may consider you for additional training as a poll book/equipment specialist.

Additional Comments

Notes to City Clerk

Please use this space to provide any additional comments that you would like the City Clerk to receive.

Signature

By typing your complete name below, you are signing this form electronically. Furthermore, you are affirming that all information provided on this form is complete and correct to the best of your knowledge.*

Send me a copy of my responses

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