2. Apply to be an Election Inspector or Chief Inspector by submitting this form.
   Job Description and Details
4. Last Name*
5. First Name*
6. Middle Initial
8. Address*
10. City*
11. State*
12. Zip Code*
14. Phone Number (Home)
15. Phone Number (Work)
16. Phone Number (Mobile)
18. Email*
19. Where would you like to work?*

    1. Polling Location
    2. Central Count
    3. No Preference
21. Which elections are you available to work?*

    1. 2022 Spring Primary - Tuesday, February 15
    2. 2022 Spring Election - Tuesday, April 5
    3. 2022 Fall Primary - Tuesday, August 9
    4. 2022 General Election - Tuesday, November 8
    5. 2023 Spring Primary - Tuesday, February 21
    6. 2023 Spring Election - Tuesday, April 4
23. For a two-year term*, please mark your preference(s) below:*

    1. CHIEF INSPECTOR (work each election as needed; must be a resident of the City of Green Bay)
    2. ELECTION INSPECTOR (work each election as needed; must be a resident of Brown County)
25. This is a paid position, are you able to provide a copy of your Social Security Card as well as fill out new hire paperwork for the City of Green Bay?*

    1. Yes
    2. No
26. Have you ever been convicted of any felonies?*

    1. Yes
    2. No
28. Are you a high school student 16 or 17 years of age?*

    1. Yes
    2. No

    If yes, we will reach out with additional information after you submit this application.
30. Have you worked as an Election Inspector or Chief Inspector in the City of Green Bay before?*

    1. Yes
    2. No
31. If yes, in which ward(s) and what years?
33. What languages are you fluent in, other than English?*

    1. None, only English
    2. Spanish
    3. Hmong
    4. Somali
    5. Other (please specify)
34. What other language(s) are you fluent in?
36. Is there anyone you would like to work with?

    Please list individuals first and last name. We cannot guarantee that we will be able to fulfill every request.

38. 1. I certify with the below statement.

    I certify that I am a U.S. citizen, at least 18 years of age, and a resident of Brown County Wis. Stat. § 7.30(2)(a). I also certify that all of the answers to the questions in this application are true, and I agree that any misstatements or omissions of act will cause forfeiture on my part of rights to employment in the City services. (A copy of this Application shall be considered as valid as the original.)
40. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
42. Electronic Signature
44. Additional Questions?
    Please contact our Clerk's Office at 920-448-3011.
Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit Submit and Print

* indicates a required field