ELECTION OFFICIAL APPLICATION FORM

NAME & ADDRESS

First Name

Last Name

Telephone

Alternate Telephone

Address

Address 2

City/Town

Province

Postal Code

Country

EDUCATION - mark highest level completed

High School

College/University

Business Technical

Graduate

ADDITIONAL INFORMATION

Have you ever worked an Election in the past?

Yes

I certify that I am a Canadian citizen, permanent resident, or foreign national with authorization to work in Canada.

Yes

Have you ever been convicted of an election offense?

Yes

If "yes," please explain:

Briefly explain your interest in working at the 2026 General Election and list any previous experience:

Declaration of Official Intent:

I am not and will not become a candidate, candidate representative or financial agent while holding the position of an election official.

Signature

Sign above

Date