offical seal
Placer County Human Resources Department
#2020-11805-01
Supplemental Questionnaire

Last Name First Name
 

 

This questionnaire will not be scored but will be used in determining assignment placement.
1.

Are you at least 18 years of age (or a minimum of 16 years of age if participating in the Student Poll Worker Program)?
Yes No
2.

Are you a registered voter in the State of California?
Yes No
2a.

If you are not a registered voter, are you a permanent legal resident of the United States?
Yes No
3.

Are you able to read and write fluent English?
Yes No
4.

Are you able to attend a two-week mandatory training class in October? Elections Aides will be notified of the training dates and times in their appointment letter.
Yes No
5.

Are you available to work Saturday, October 31 through Tuesday, November 3?
Yes No
6.

In addition to English, please select the language(s) in which you are fluent in speaking:  
Spanish
Tagalog
Punjabi
Korean
7.

Have you retired from the California Public Employees' Retirement System (CalPERS) or another retirement system?
Yes No
8.

Do you have any restrictions on being assigned to work at or within 100 feet of a school?
Yes No

 

Thank you for completing the supplemental questionnaire portion of the application process. We encourage applicants to review their answers for accuracy prior to submitting.

Please Save & Continue to move forward to the next tab. 

Be sure to select the "Submit" button once the application has been completed.  You will receive confirmation that the application has been submitted.