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State of Michigan Election Inspector Application

  1. State of Michigan Election Inspector Application

  2. Personal Information

  3. Registered in

  4. Political Party Affiliation (must be a recognized state party & may not be independent)

  5. Have you ever been convicted of a felony or election crime?

  6. Education and Experience Informaion

  7. Please rate your computer experience (data Look-up, database processing, creating pdfs, etc.): 1 = not experienced, 5 = very experienced

  8. Do you have transportation?

  9. Will you work at any polling place?

  10. Signature and Certification

    I CERTIFY THAT I am not a member or a known active advocate* of a political party other than the party identified above. I FURTHER CERTIFY THAT the foregoing statements are true to the best of my knowledge and belief.

  11. * A "known active advocate" of another political party is defined to mean a person who 1) is a delegate to the convention or an officer of another party; 2) is affiliated with another party through an elected or appointed government position or; 3) has made documented public statements specifically supporting by name another political party or its candidates in the same calendar year as the election at which the peron will serve as an inspector. "Documented public statements" means statements reported by the news media or written statements with a clear and unambiguous attribution to the applicant.

  12. Do you Agree?*

    By clicking "I agree", you agree and acknowledge that 1) your application will not be "signed" in the sense of a traditional paper document and 2) By signing in this alternate manner, you agree that your "electronic signature" is valid and binding upon you to the same force and effect as a handwritten signature.

  13. ANY FALSE STATEMENTS MADE ON THIS APPLICATION WILL DISQUALIFY THE APPLICANT

  14. Approved by State Director of Elections (June 2015)

  15. Leave This Blank:

  16. This field is not part of the form submission.