Registrar of Voters

501 Main Street South
(Room 106)
Southbury, CT 06488
Maps and Directions

P:(203) 262-0644
Monday - Thursday:
8:00am - 4:30pm
Friday: Closed

Poll Worker Application Form

Poll worker Training Standards:

Conn Gen Stat 9-192 requires the Secretary of the State, in consultation with an advisory committee created to establish programs and procedures for training, examining, and certifying registrars of voters, deputy registrars of voters, and assistant registrars of voters, to develop a training program in election procedures for poll workers. All poll workers must complete the appropriate level of training before serving at the polls.

Training is required before each Primary or Election.

If I fill out the interest form, am I obligated to be a poll worker?

No, completing the poll worker interest form puts you on a list to be contacted by your registrar of voters to gather information. If you meet the qualifications, you will need to attend a training session before being assigned a polling location during Early Voting or on Election Day.

In addition, we strive to fill most positions five weeks prior to an election. If you are applying after that time frame it is unlikely you will be called for that election, but we will keep you on the list.

Application/Interest Form:

CitizenshipAre you a U.S. Citizen?

Registered to VoteAre you registered to vote in Connecticut? (Must be 18 years of age.)

First Name

Last Name

Date of Birth

RESIDENTIAL ADDRESS

Residential Street

Residential City or Town

Residential Zip Code

MAILING ADDRESS (if different from residential address)

Street

City or Town

Zip Code

Email Address

Primary Phone Number

Alternate Phone Number

OccupationWhat is your current/last occupation?

Previous Poll Worker ExperienceHave you ever served as a poll worker?

Details of Previous Poll Worker ExperienceIf you answered “Yes” above, where & when did you work?

Other LanguagesAre you able to assist voters in a language other than English? If yes, please list.

DutiesPlease indicate what types of duties you would be comfortable undertaking. (Check all that apply.)

Greeting electors and line management “Checker” – verifying & cross electors off of paper street list Distributing ballots & entering electors on a computer/poll book Tabulator tender Moderating polling location (requires certification)

Standby Poll WorkerAre you willing to be a “stand-by” poll worker? As a stand-by poll worker you will be notified to report to work only if your services are needed.