Temporary Election Staff Application Form
Police and Crime Commissioner Election- 5 May 2016
Section 1: Personal Information
Surname
Forename
Title
Address
Postcode
Telephone (Home)
Telephone (Work)
Mobile
Email address
Date of Birth
Nationality
Gender
National Insurance Number
Do you have access to a car?
Are you eligible to work in the UK?
Please give your job title and department if
you work for South Oxfordshire and Vale of
White Horse District Councils
Please give your line manager/supervisor
name if you work for South Oxfordshire and
Vale of White Horse District Councils
Section 2: The job(s) I would like to apply for, please tick applicable boxes
I would like to
apply for this job
I have done this job
before
No. of occasions I have
done this job
Presiding Officer*
5 May
Poll Clerk
5 May
Postal Vote Opening
Assistant
various dates between 20
April and 5 May
Verification Assistant
5 May, from 10pm till
approx. 2am
Count Assistant
During the day on 6 May
* To be a presiding officer we prefer for you to have been a poll clerk at least twice before
If applying for Presiding Officer/ Poll Clerk – Polling Station preference (not guaranteed):
If we cannot place you in your preferred station, how far would you be willing to travel? :
If I do not get selected initially, I am happy to be put on a reserve list and be contacted at short
notice:
Yes/No
Please give any relevant information or experience that may support your application:
I am unavailable to work on this election but would like to remain on your database for future
elections:
Yes/No
Section 3 – Declaration
1) I confirm that I am not connected to, nor will assist any political party or candidate at these elections.
If I become aware of any possible conflict, I will notify the elections office immediately.
2) I am physically able to undertake the duties of the task I am applying for.
3) I am entitled to work in the UK and understand that if I am a new employee and appointed to a
position I must present the required proof of right to work documents.
Please note filling in this form does not guarantee you employment, however, we will try and
find all suitable candidates a role.
Signed
Where did you hear about this vacancy? :
Date