Election Application for Personnel Positions Step 1 of 4 25% I. Election Assistant ApplicationPope County is recruiting qualified individuals to serve as Elections Assistants for the upcoming Election. Even if you have previously served, or have expressed an interest in helping the community by serving as an Elections Assistant, we require you to fill out this applicationII. Equal Employment OpportunityIt is the policy of Pope County to provide equal employment opportunity for all, without discrimination, on the basis of race, color, creed, religion, national origin, sex, marital status, status with regard to public assistance, disability, sexual orientation, or age.III. Data Privacy Notice/Tennessen WarningIn accordance with the Minnesota Government Data Practices Act, Minnesota Statutes Chapter 13, you are hereby informed that the information requested on this application is being collected by Pope County for the purpose of evaluating your qualifications and suitability for employment and administering the County's recruitment and selection process. You are not legally required to provide the information requested on this application; however, failure to provide complete and accurate information may prevent Pope County from fully evaluating your qualifications and may result in your application not being considered for employment. Providing the requested information permits Pope County to consider your application and qualifications for the position for which you are applying. Information you provide may be used by Pope County officials, employees, agents, consultants, and others whose work assignments reasonably require access to the information for purposes related to the recruitment, selection, and employment process. Information may also be disclosed to other persons or entities when authorized or required by state or federal law, including pursuant to a valid court order, or to the Minnesota State Auditor or Legislative Auditor when authorized by law. Under Minnesota Statutes § 13.43, subdivision 3, certain information concerning applicants for public employment is classified as public data, including veteran status, relevant test scores, rank on an eligible list, job history, education and training, and work availability. Your name is generally private data unless you are certified as eligible for appointment to a vacancy or are considered a finalist for the position. A finalist is an individual selected to be interviewed by the appointing authority prior to selection. Other applicant personnel data are generally classified as private data unless otherwise provided by law. By submitting this application, you acknowledge that you have received and understand this Data Privacy Notice/Tennessen Warning.Date available to begin employmentMonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920IV. Personal DataName(Required) First Last Address(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone(Required)Email Address(Required) Have you previously worked for Pope County? Yes No If yes, position held/department(Required)If yes, under what name may your previous employment records be found?(Required) First Last V. Election ExperienceHave you ever worked as an election judge or on an absentee ballot board for an election in Minnesota? No Yes, in the last two years Yes, more than two years ago If you have prior experience as a Minnesota election judge or have worked on an absentee ballot board, please explain when and where.Why are you interested in the Temporary Elections Assistant position with Pope County?(Required)What work experience or skills do you have that you believe would help you succeed in this position?(Required) X. Veteran StatusAre you an honorably discharged veteran of the armed forces of the United States or are you otherwise eligible to claim Veteran’s Preference Points? Yes No Are you the spouse of a deceased honorably discharged veteran or disabled veteran who is unable to work due to such disability? Yes No Do you wish to claim Veteran’s Preference Points? Yes No If you are a disabled veteran and wish to claim additional points, please check here. If you are a disabled veteran and wish to claim additional points, please check here. XII. State and Pope County RequirementsAre you a United States Citizen?(Required) Yes No Are you an Eligible Voter in the State of MN?(Required) Yes No Are you able to read, write, and speak English?(Required) Yes No Are you a candidate running for office at this election?(Required) Yes No Are you the spouse, parent, step-parent, child, step-child, sibling, or step-sibling of any election judge serving in Pope County?(Required) Yes No Are you the spouse, parent, step-parent, child, step-child, sibling, or step-sibling of any candidate running for office at this election?(Required) Yes No Are you currently living with, either permanently or temporarily, any candidate running for office at this election?(Required) Yes No I agree to be courteous and respectful, and to assist all voters regardless of race, color, creed, religion, national origin, sex, marital status, status with regard to public assistance, disability, sexual orientation, age, or proficiency in the English language.(Required) Yes No I will refrain from making personal and political comments while serving as an Election Assistant.(Required) Yes No I authorize Pope County to verify the information I have provided in this application.(Required) Yes No XIII. Certification, Acknowledgment, Authorization and ReleaseI certify that the answers I have given on this application are true and correct to the best of my knowledge. I understand that any false or misleading information provided, or any omission or concealment of facts, will disqualify me for consideration for employment, and constitutes grounds for my immediate dismissal should I be employed by the County. I understand, acknowledge, and agree that no offer of employment is valid or binding until formal approval by the County Board or the appointing authority referenced in the job description and that until such approval the County shall not be liable for any reliance on any oral or written offers of employment made to me. If an offer of employment is made, such offer will be contingent upon the successful completion of a background check. I hereby release the County and all agents acting on behalf of the County, of any and all liability.Date(Required)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Electronic Signature(Required)CAPTCHA
