Democracy MVP
Election Worker Interest Form

Are you interested in serving as an election worker? Complete the form below to indicate your interest for future Michigan elections!

For more information about employment opportunities as an election worker, contact your local election clerk's office or learn more at Michigan.gov/DemocracyMVP.

*required

Question Title

* First Name:

Question Title

* Last Name:

Question Title

* Middle Initial:

Question Title

* Email Address:

Question Title

* Telephone (XXX-XXX-XXXX):

Question Title

* Address where you are registered to vote. (If you are 16-17, please provide your residential address.)

If you are 18+ you must be registered to vote to serve as an election worker. If you are not currently registered, or aren’t sure if you are registered, you can visit Michigan.gov/VoterRegistration to register today or check your registration status.

Address

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Question Title

* County where you live:

Question Title

* County where you would prefer to work:

Enter any additional counties you'd like to work in here.

Question Title

* Distance you're willing to travel to work (one-way):

The Michigan Department of State (MDOS), in an effort to ensure safe and secure elections, is recruiting members of the public to serve as election inspectors (“Democracy MVP”).
In clicking on the link, you agree to provide MDOS your name, your email address, and/or your phone number (also known as personally identifiable information) via a third party survey collection entity. You also consent to MDOS providing your information to local clerks for them to decide whether you can serve as an election inspector for Michigan state and local elections.
MDOS warrants that it will not use your personal information provided here for any other purpose than to further the initiative of the Democracy MVP process. MDOS will retain your personal information for five years, as required by state retention laws.
MDOS is not responsible for how any local clerk’s office uses, stores, or retains your PII.
For more on MDOS’ privacy statement, please go to: https://www.michigan.gov/sos/0,4670,7-127--281460--,00.html

Page1 / 3

33% of survey complete.

Democracy MVP Election Worker Interest Form

Question Title

* First Name:

Question Title

* Last Name:

Question Title

* Middle Initial:

Question Title

* Email Address:

Question Title

* Telephone (XXX-XXX-XXXX):

Question Title

Question Title

* County where you live:

Question Title

* County where you would prefer to work:

Question Title

* Distance you're willing to travel to work (one-way):

Democracy MVP
Election Worker Interest Form