Election Judge (Poll Worker) Application

Election Judge (Poll Worker) Application

This form must be completed if you would like to work during the 2023 or 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:

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. Additional and specialized training (Chair Judge, healthcare voting, equipment specialist, etc.) will be conducted in-person. The dates/times of those trainings will be communicated to those that are selected to serve in those roles.

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*

State of Minnesota Requirements to Serve as an Election Judge:

Must be a United States citizen
Must be an eligible voter in the State of Minnesota
Must be able to read, write and speak English
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
Must not be a candidate at that election

By checking this box I am confirming that I meet the above requirements to serve as an Election Judge.*

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.

How did you hear about this opportunity?

Check all that apply

Select or enter value

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

2024 Availability*

Check all that apply

Select or enter value

What hours are you available to work on November 5, 2024?*

Check all that apply

Select or enter value

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

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.

Employment Information

State law allows for time off from work to serve as an election judge without loss of wages.

To qualify, you must provide your employer with at least 20 days written notice and the pay rate you will receive to serve as an election judge. Elections & Voter Services will provide you with this notice.

Your employer may:

Reduce your salary or wages by the amount you are paid as an election judge during the time you are away from work
Restrict the number of its employees serving as election judges to no more than 20 percent from a single work site

You may voluntarily take a vacation day to be fully paid by your employer and receive election judge pay as extra income; however, an employer may not force you to take vacation or any other form of paid leave.

You may give this letter to your employer, provided by the Office of the Minnesota Secretary of State, to explain the law regarding time off from work to serve as an election judge.

Payroll Notification and Volunteer Option*

All judges must be paid via direct deposit and are required to complete all necessary payroll documentation. However, if you would like to volunteer your time and not receive payment, you must make this decision and notify the City Clerk no later than ten days before the election (per M.S. 204B.31, subd 2.).

Please indicate below whether or not you would like to be paid or volunteer your time as an election judge.

Select

Are You Currently Employed*

Select

Does your employer require a letter of service from our office to document the hours you will be working on Election Day?*

Select

Please provide your employer's contact information so that a letter can be sent.*

(Email is preferred)

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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