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ELECTION JUDGE NAIRE

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					                            Montgomery County Board of Elections
                      ELECTION JUDGE QUESTIONNAIRE
                                           PLEASE COMPLETE AND RETURN AS SOON AS POSSIBLE TO:
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                                                                          MONTGOMERY COUNTY                                                                                    Official Use Only
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                                                                          BOARD OF ELECTIONS
                                                                             P.O. BOX 4333
                                                                         ROCKVILLE MD 20849-4333
Dear Voter:
The Montgomery County Board of Elections is recruiting qualified individuals to serve as Election Judges. You have
been contacted in the hope that you will consider helping the community by serving as an Election Judge. If you are
interested, please complete and return this form. Thank you.

PART A:          QUALIFIERS

1. Are you a registered voter in Maryland? ..............................................................................................................                                      YES             NO

2. Are you a candidate for or do you currently hold public or political party office?...............................................                                                           YES             NO
         (Includes municipal officials and central committee members)

3. Are you a chairman, campaign manager or treasurer for a political or candidate committee? ............................                                                                      YES             NO

4. Do you read, write and speak the English Language? ...........................................................................................                                              YES             NO

5. Have you been an Election Judge within the last 2 years? ...........................................................................................                                        YES             NO
                 (If yes, please skip # 6)

6. Please select the Election Judge Position you are interested in. (for position descriptions see Part F, #2)

                                 Voting Operations                         Closing                       Both

7. Please select all elections you are interested in working:

                                 Early Voting                              Primary Election                        General Election

 PART B:         CONTACT INFO


Name:                                                                                        Date of Birth:                                                      Gender                 Male              Female

SSN: (See Part F, #1)                                  Residential Address:                                                                                                      Apt #

City:                                             State:    21                                          Zip Code:                                County:

Mailing Address: (if different)                                                                                                                                             Apt #

City:                                              State:                                                Zip Code:

Home Phone:                                       Cell Phone:                                      Work Phone:                                                   Ext.

Email 1:                                                                                      Email 2:

Emergency
Contact:  Name:                                                                     Phone Number:                                                    Relation:

Do you need to work with another judge? List name.
Would you like to go to paperless for future correspondence? ...................................................................................................                               YES             NO


PART C:          LANGUAGE


1. Do you read, write and speak any other language, including sign languages in addition to English? ...................................                                                      YES              NO
                              If yes, what languages?
2. Do you require a sign language interpreter to participate? .....................................................................................................                            YES             NO




                                              WE NEED YOU...
                                              Serve Your Community...Be An Election Judge!
                                                                                                                      Montgomery County Board of Elections, Maryland Election Judge Questionnaire Online form: 3-29-10 Ep
PART D:     PLEDGE                                                              PART E:            OATH, NOTICE
                                                                             (Your signature is required. Questionnaire will not be processed without your signature)
To ensure fair and honest election results, I certify that:

1. I agree not to (1) hold or be a candidate for any elective public or                     Please Print Name and Sign.
political party office or any other office created under the Constitution
or Laws of the State; (2) use my official authority as an Election Judge     I, _________________________________________
for the purpose of influencing or affecting the results of an election; or
(3) while performing Election Judge duties on Election Day or during         a registered voter residing in Maryland at the address given, under
early voting not to serve as a campaign manager for a candidate or as        the penalty of perjury, do swear (or affirm) that I will support the
the treasurer for a campaign finance entity.                                 Constitution of the United States; and that I will be faithful and
                                                                             bear true allegiance to the State of Maryland, and support the
2. I affirm I am not currently running for or holding public or political    Constitution and laws thereof; and that I will, to the best of my
party office (including municipal offices and central committee              skill and judgment, diligently and faithfully, without partiality or
members). I am not a chairman, campaign manager or treasurer for a           prejudice, execute the office of Election Judge for Montgomery
political or candidate committee.                                            County in the State of Maryland, according to the Constitution
                                                                             and laws of this state from the date of my appointment until
3. As a Chief Judge or Voting Operation Judge, I will arrive at my           (thirteen weeks prior) to the next primary election unless excused
assigned polling place by 6:00 a.m. As a Closing Judge, I will arrive at     for good cause by Montgomery County Board of Elections.
my assigned polling place by 6:30 p.m. on Election Day and remain
until excused by the Chief Judge.
                                                                             ___________________________                                                       ____________
4. I will NOT leave the polling precinct, for any reason, at anytime                              SIGNATURE                                                                DATE
during Election Day while the polls are open between the hours of 7:00
a.m. and 8:00 p.m. I understand I will be relieved by a Chief Judge or         NOTICE TO ELECTION JUDGE APPLICANT
Voting Operation Judge during slow voting periods for meals and              In the event you are selected to serve as an Election Judge in
breaks as determined by the Chief Judge.                                     Montgomery County, the signed oath above will constitute your
                                                                             commission. Pursuant to the Annotated Code of Maryland,
5. I agree to be courteous, respectful and to assist all voters regardless   Article 33, section 10-206(f), Election Judges are required to
of national origin, race, creed, gender, age, physical challenge or          attend a training class about legal procedures and duties and
proficiency in the English language.                                         responsibilities. A stipend is paid for each Election Day served.
                                                                             Election Judges must attend training and work on Election Day
6. I agree to wear the name tag supplied by the Montgomery County            or as an authorized Standby Judge to receive any compensation.
Board of Elections at all times while performing my duties as an             You will be officially notified of your appointment and assigned
Election Judge.                                                              to a training class.

7. I agree to read and study the Election Judge Training Manual and          PART F: POSITION DESCRIPTION, CONTACT INFO
any additional information. I will attend Election Judge Training as
                                                                             1. Social Security Number: All Election Judges who wish to
scheduled so that I am prepared to fulfill my responsibility to conduct      receive a stipend must provide a Social Security Number. If you
the election according to federal, state and local election laws and         do not wish to receive the stipend, a signed letter stating so needs
policies. I will attend the Monday night pre-election meeting.               to be returned with this questionnaire to the Board of Elections.

8. I understand that I am responsible for the security of the election       2. Election Judge Positions:
equipment and supplies and I will handle and monitor all such                         a. Voting Operations Judges serve all day. They are
equipment and supplies exactly as instructed. These materials include,                    responsible for checking-in voters, assisting voters
but are not limited to: Touch Screen Voting Units, Electronic Poll                        with the voting process and processing provisional
Books, Passwords, Integrity Documents, Supervisor Cards,                                  voters.
PC Memory Cards, Encoders, Keys, Voter Access Cards, Precinct
                                                                                      b. Closing Judges assist Chief Judges with the Voting
Registers, Voter Authority Cards, Provisional Ballot Applications,                        Unit shut down and closing procedures after the
and Provisional Ballots both voted and unvoted.                                           precinct has closed. Closing Judges are responsible
                                                                                          for delivering the precincts' critical materials to the
9. I agree to complete all documentation required by federal, state                       Board of Elections in Gaithersburg on Election Night.
and local election laws for my assigned position's responsibilities as                    Cell Phone and own transportation are required.
accurately and completely as possible including voter canvasses,                      c. Standby Judges are a reserve force of Elections
Election Day logs and any other documentation designed to reconstruct                     Judges called upon to replace judges who have
the election or to document that the number or persons appearing to                       withdrawn prior to or on Election Day.
vote and the number of votes cast guarantee a fair and honest outcome.
                                                                             3. Election Day Assignment: Election Judges must complete
                                                                             training prior to receiving their work assignment. Every effort is
10. I agree to report immediately to the Chief Judge any malfunction         made to place Election Judges in their voting or home precinct.
or possible tampering of the voting equipment, unusual or suspicious         Once all positions are filled, remaining Election Judges will be
behavior occurring in the polling room, or any other event or                placed in nearby precincts or assigned as a Standby Judge.
occurrence that may threaten accurate gathering or sanctity of the vote.
                                                                             4. Training: All Judges must complete the required training to
                                                                             be eligible to serve. Judges will be provided with training
11. I agree not to use my personal cell phone for personal calls, text       information and instructions on how to sign-up for training via
messaging, photographs, and web browsing while performing my                 our online system or by phone.
duties as an Election Judge in the polling room. I agree not to take
any photographs in the polling room.                                         5. Stipend: Election Judges are paid for attending training and
                                                                             working Election Day. Checks are mailed four - six weeks
                                                                             following the General Election. If you cannot or do not want to
12. I agree NOT to bring newspapers, magazines or other public               accept the stipend you must provide a signed letter prior to
information materials into the polling room.                                 Election Day stating your desire not to be paid. You must provide
                                                                             your Social Security Number to receive a stipend.
                                                                             GENERAL INFORMATION .................................. 311 or 240-777-8533
                                                                             DEMOCRATS .................................................................... 240-777-8570
                                                                             REPUBLICANS & OTHERS ............................................. 240-777-8575
                                                                             MD RELAY........................................................................................... 711
                                                                             FAX ..................................................................................... 240-777-8578
                                                                             E-mail ........................................ Democrats@montgomerycountymd.gov
                                                                                                                           Republicans@montgomerycountymd.gov
                                                                             WEB SITE .................................................................... www.777vote.org
                                                                                                                                  www.montgomerycountymd.gov/311
                                   WE NEED YOU...
                                   Serve Your Community...Be An Election Judge!
                                                                                                  Montgomery County Board of Elections, Maryland Election Judge Questionnaire Online form: 3-29-10 Ep

				
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