Fillable Election Officer Application
Election System of the Virgin Islands Sunny Isle Shopping Center, Christiansted, St. Croix, V.I. (340) 773-1021 Crystal Gade, St. Thomas, V.I. (340) 774-3107 P.O. Box 1499 Kingshill St. Croix U.S. Virgin Islands 00851 / P.O. Box 6038 St. Thomas U. S. Virgin Islands 00801 APPLICATION FOR ELECTION OFFICERS PERSONAL INFORMATION NAME: ____________________________________________________________ PHYSICAL ADDRESS: ________________________________________________ MAILING ADDRESS: __________________________________________________ TELEPHONE #: ______________________________________________________ DATE OF BIRTH: _________________ LAST FOUR OF SSN #: _______________ GOVERNMENT EMPLOYEE NUMBER: _________________ NUMBER OF DEPENDENTS: ______________ ARE YOU A REGISTERED VOTER? …
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Election System of the Virgin Islands Sunny Isle Shopping Center, Christiansted, St. Croix, V.I. (340) 773-1021 Crystal Gade, St. Thomas, V.I. (340) 774-3107 P.O. Box 1499 Kingshill St. Croix U.S. Virgin Islands 00851 / P.O. Box 6038 St. Thomas U. S. Virgin Islands 00801 APPLICATION FOR ELECTION OFFICERS PERSONAL INFORMATION NAME: ____________________________________________________________ PHYSICAL ADDRESS: ________________________________________________ MAILING ADDRESS: __________________________________________________ TELEPHONE #: ______________________________________________________ DATE OF BIRTH: _________________ LAST FOUR OF SSN #: _______________ GOVERNMENT EMPLOYEE NUMBER: _________________ NUMBER OF DEPENDENTS: ______________ ARE YOU A REGISTERED VOTER? _____ YES _____ NO PARTY AFFILIATION: (Circle One) DEMOCRAT REPUBLICAN ICM NO PARTY POLLING PLACE IN WHICH YOU ARE REGISTERED; _________________________ WHAT LANGUAGE ARE YOU FLUENT IN: __________________________________ LIST PREVIOUS EXPERIENCE AS ELECTION OFFICERS OR YOUR PRESENT WORK HISTORY POSITION TITLES AND DUTIES: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ I, certify that the information given above is correct and true to the best of my knowledge. __________________________ ___________________________ Date Signature ELECTION SYSTEMS OF THE VIRGIN ISLANDS FORM 0020-REVISED 2010 SIGN