Full Name * Date of Birth * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 Email Address * Home Address * Phone Number * Are you a registered voter in the City of St. Ignace? * Yes No Political Party Affiliation * REQUIRED; must be a recognized state party & may not be Independent). Republican Democratic Libertarian U.S. Taxpayers Green Natural Law Working Class Have you ever been convicted of a felony or election crime? * Yes No Education Background * Include highest grade completed or degree held Employment Background * Include current or last place of employment and type of work performed Languages other than English that you speak (if any) Please rate your computer experience (data look-up, database processing, creating .pdfs, etc.) * 1=not experienced, 5=very experienced 1 2 3 4 5 Past experience as an election inspector, if any: Include name of jurisdiction Do you have transportation? * Yes No 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. * Confirm Leave this field blank
