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2. First Name*
3. Last Name*
5. Address1
7. Address2
9. City
10. State
11. Zip
13. Phone Number
15. Email
17. Have you been a judge before?*

    1. Yes
    2. No
19. How did you hear about this opportunity?
21. Please consider me as an election judge for the:*

    1. Presidential Primary
    2. Primary Election only
    3. General Election only
23. I prefer to work:*

    1. All Day
    2. Morning Only (6 a.m. - 2 p.m.)
    3. Afternoon/Evening Only (1:00 p.m. to approximately 10:00 p.m.)
    4. Either Half Day Shift
25. Age Verification: *

    1. Under 18 years of age
    2. Over 18 years of age
27. Preferred Precinct:*

    1. Precinct No. 1 – Rice County Fairgrounds, 4-H Building, 1900 Fairgrounds Drive
    2. Precinct No. 2 – Washington Center, 117 Shumway Avenue
    3. Precinct No. 3 – Faribault Community Center, 15 Division Street West
    4. Precinct No. 4 – Our Savior’s Lutheran Church, 1207 Prairie Avenue South
29. My Political Party Affiliation:

    1. Democratic-Farmer-Labor Party
    2. Republican Party
    3. Legal Marijuana Now Party
    4. Grassroots-Legalize Cannabis Party
    5. No Party Affiliation
31. I am interested in serving as a Head Election Judge:*

    1. Yes
    2. No
33. Tennessen Warning *
    -- Select One --I understand

    Notice to All Applicants:

    TENNESSEN WARNING

    In accordance with the Minnesota Government Data Practices Act, the City of Faribault is required to inform you of your rights as they relate to the private information collected from you.   

    1. The Purpose and Intended use of the information collected

    • The information we collect about you is classified by law as either public (anyone can see the information), or private (only you can see the information), or confidential (you cannot see the information).
    • The purpose and intended use of this is to aid the City of Faribault in determining your qualifications to be an election judge.

    2. May you refuse or are you legally required to Supply the Information we ask for?  What are the Consequences of your Supplying or Refusing to Supply the Information?

    • You have the right to refuse to supply the information requested and there is no legal requirement that you provide the information requested.
    • If you supply the information requested, it will aid the City of Faribault in determining your qualifications essential for appointment as an election judge.
    • If you refuse to supply the information, your application may be considered incomplete and may disqualify you from being appointed as an election judge.

    3. Who has Access to the Private and Confidential Information we collect About You?

    • Individuals within the City of Faribault will have access to the information.
    • Individuals or agencies for which a state statute, federal law or the State Commission of Administration authorizes a new use or sharing of the information after you have been given this notice.
    • Unless otherwise authorized by state statute or federal law, government agencies with which we share private or confidential information may also treat the information they receive as private or confidential.
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37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field