Temporary Election Staff Application Form
EU Referendum 23 June
SurnameForename
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 jobPresiding Officer*
23 June
Poll Clerk
23 June
Count Assistant
Overnight 23 June
Runner
9.15 pm till 12am
* To be a presiding officer we prefer for you to have been a poll clerk at least twice before
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 / DateWhere did you hear about this vacancy?: