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2. Election Judges must meet Minnesota state requirements:
   • Must be a United States citizen
   • Must be an eligible voter in the State of Minnesota
   • Must be able to read, write, and speak English
   • Must not be the spouse, parent, stepparent, child, stepchild, sibling, or stepsibling of any election judge serving in the same precinct or of any candidate at that election
   • Must not be domiciled, either permanently or temporarily, with any candidate on the ballot at that election
   • Must not be a candidate at that election
4. I understand and meet Minnesota State Election Judge requirements stated above

   1. Yes
   2. No
6. Name
7. Email address
9. Street Address
11. City
12. State
13. Zip Code
15. Phone number
16. Emergency Contact - Name & Phone Number
18. The State of Minnesota requires major political party balance in polling places (Minnesota State Statute 204B.19, Subd 5). For Election Day staffing purposes, please state which major political party you are willing to represent:

    1. Democratic Farmer Laborer
    2. Republican
    3. Legal Marijuana Now
    4. Grass Roots - Legalize Cannabis
    5. Other or Not Affiliated with a Political Party
20. Do you have experience with an iPad or Computer?

    1. Yes
    2. No
22. Do you have a relative serving as an election judge in Lino Lakes?

    1. Yes
    2. No
23. If you have a relative serving as an election judge, list name.
25. I am interested in serving as an Election Judge.

    1. Yes
    2. No
26. I am interested in serving as a Head Judge.

    1. Yes
    2. No
27. 2022 Election Days are August 9th and November 8th; please check box indicating your availability:

    1. State Primary Election, August 9, 2022
    2. State General Election, November 8, 2022
29. I prefer to work:

    1. All Day
    2. AM only (6 am to 1 pm)
    3. PM only (1 pm to 9 pm)
30. Polling Locations - Choose preferred location

    1. No preference - schedule where needed
    2. P1 Lino Lakes Senior Center - 1189 Main Street
    3. P2 Lino Lakes Fire Station 1 - 7741 Lake Drive
    4. P3 St. Joseph's Catholic Church - 171 Elm Street
    5. P4 Lino Lakes City Hall - 600 Town Center Parkway
    6. P5 Rice Lake Covenant Church - 125 Ash Street
    7. P6 Lino Lakes Fire Station #2 - 1710 Birch Street
    8. P7 Living Waters Lutheran Church - 865 Birch Street

32. Pay: The City pays election judges $12 per hour (head judges $14 per hour) for attending training sessions and performing Election Day duties. Direct deposit of wages is required.

    A wage bonus of $1 or $2 an hour is added for state general elections.

    Employer Certificate: An individual who is selected as an election judge may be absent from their place of work for the purpose of serving as an election judge and election judge training without penalty if they notify their Employer in writing at least 20 days prior to each election.

    If you would like to receive a copy of Minnesota Statute 204B.195 Employer Certificate, please email us.

34. Signature

    Notice to Applicants:  In accordance with the Minnesota Government Data Practices Act (Minn. Stat §13.04, Subd. 2), we must inform you of your rights as a subject of data.  The purpose and intended use of the requested data is to identify you and assist in determining your suitability as a Lino Lakes Election Judge.  You are not legally required to supply the requested data.  However, if you refuse to supply the requested information, your Election Judge application will not be considered.  If you do provide the data, your application will be considered, and if you are employed, the data you have supplied will become part of your Election Judge record.  Any information you provide as an applicant or as an Election Judge during your service with the City of Lino Lakes, may be used by the City for a variety of purposes under human resources rules or as required by law.  This includes, but is not limited to, performance appraisals and discipline.

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36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

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