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2. Serve as an Officer of Election in the City of Charlottesville
   Officers of Election must be registered voters in Virginia. Each appointee must be willing to represent the interests of either the Democratic or Republican Party, but party membership is not required. Officers of Election are compensated for trainings and working on Election Day. Three shift options are available on Election Day: 5:00 AM until closing; 5:00 AM until 1:00 PM; or, 12 Noon until closing. If you would like to apply for appointment, complete and submit this form. The Electoral Board appoints officers in accordance with section 24.2-115 of the Code of Virginia.
4. Name
5. Email Address
7. Address
9. City
10. State
11. Zip Code
13. Phone Number
14. Fax Number
16. YEAR OF BIRTH:
17. LAST 4 DIGITS SSN:
19. EMPLOYMENT AND/OR VOLUNTEER EXPERIENCE:
21. What shift do you prefer?

    1. AM
    2. PM
    3. ALL DAY

    Please select.
23. ELECTRONIC SIGNATURE
24. DATE
26. FOR OFFICE USE ONLY
    Reg to Vote__________ Precinct NO:__________ Electoral Board Action___________ Date Letter Sent_____________
Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

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