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* 1. Please enter your contact information.

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* 2. ETHNICITY

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* 3. GENDER

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* 12. IF YES, PLEASE IDENTIFY THE LANGUAGE(S):

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* 13. WHY DO YOU THINK POLL WORKERS ARE IMPORTANT TO CONDUCT ELECTIONS?

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* 17. SELECT DATE

Date

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* 19. PLEASE CHECK ALL THAT APPLY AS IT RELATES TO YOUR EMPLOYMENT BACKGROUND OR SKILL SET:

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