Form Center

2. Personal Information
4. First Name*
5. Last Name*
7. Street Address*
8. Address Line 2
10. City
11. State
    -- Select One --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
12. Zip Code
14. Phone*
15. Email*
17. Are you legally entitled to work in the United States?*

    1. Yes
    2. No
18. Are you age 18 or over?*

    1. Yes
    2. No
20. Special skills and qualifications that may apply to the position (please include all computer software which you can operate skillfully):*
22. Other Information
24. Are you currently a registered member of a political party?*

    1. Yes
    2. No
25. If yes, please indicate:

    1. Democratic
    2. Republican
    3. Independent
    4. Other
27. Have you ever served as an election official?*

    1. Yes
    2. No
28. If yes, where and when?
30. I would like the following special considerations, if possible (Examples: to work with specific other individuals, to be able to leave the site for mealtimes, accessibility needs etc):
32. Where do you prefer to work?*

    1. Lisbon Town Hall (Wards 1, 6 & 7)
    2. Redeemer United Church of Christ (Wards 2, 3 & 8)
    3. Richard Jung Memorial Fire Station (Wards 4 and 5)
    4. Wherever Needed
33. Which shift(s) do you prefer to work?*

    1. Any Shift
    2. Full day (6 am to Close)
    3. Early shift (6 am to 1:30 pm)
    4. Late Shift (1:30 pm to Close)
35. Would you like to be compensated?*

    1. Yes, I want to be paid
    2. No, I want to be a volunteer.
37. Have you ever been convicted of any violations of law other than minor traffic violations?

    1. Yes
    2. No
39. Note: Convictions are not an automatic bar to employment, but are reviewed in relation to the job for which you applied. Convictions not reported may be cause for discharge.
41. Acknowledgement of Appointment Procedure*

    1. I understand the below procedure.

    Thank you for your interest in Lisbon’s election processes. Election Inspectors are generally appointed in late fall of odd-numbered years for a two-year cycle, with party-appointed persons taking preference. If we are in need of inspectors due to lack of staffing, we would then appoint additional inspectors as needed. Your name will be placed on our list for future appointment should the need arise. Otherwise, you will be contacted in late 2023 to ask if you are still interested in being appointed to the next 2-year term.

Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

* indicates a required field