Poll Manager Application

Pike County Poll Manager Application

Please fill out this form completely if you are interested in serving as a Poll Manager.

Voter Information

ARE YOU REGISTERED TO VOTE IN MISSISSIPPI? Yes No

You must be registered to vote in Mississippi to work as a Poll Manager.

VOTER REGISTRATION NUMBER

If you do not know your voter registration number please call the Pike County Circuit Clerk at (601) 783-2581 or the Pike County Election Commission (601) 783-3586.

Personal Information

NAME First Last

ADDRESS

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

PHONE - (###) - ### ####

EMAIL ADDRESS

CAN YOU WORK AT LEAST 15 HOURS? Yes No

Skills

PLEASE DESCRIBE WHAT COMPUTER SKILLS YOU HAVE

Please be as detailed as possible.

PLEASE DESCRIBE WHAT MOBILE DEVICES AND APPS YOU HAVE WORKED WITH

Disclaimer & Signature

I AFFIRM that the above information is true and accurate. I am a registered "active" voter in Mississippi. I live in Pike County. I understand that before I work an election, I must attend a training session and for certain positions, must pass a certification test. I am prepared to provide unbiased, non-partisan assitance to the voters of Pike County.

APPLICANT SIGNATURE

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Email address

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