Election Worker Form

Required fields are marked with an asterisk (*)

Privacy Statement

In accordance with Section 485 of the Municipal Government Act (MGA), any personal information collected on this form will only be used by municipal staff and, if necessary, individuals and/or organizations under service contract with the Halifax Regional Municipality for purposes relating to the administration of Municipal and School Board Elections.

If you have any questions about the collection and use of this personal information, please contact the Access and Privacy Office at 902.943.2148 or privacy@halifax.ca.

Personal Information

First name *

Last name *

Unit/Apartment

Civic number *

Street name and type *

Community *

Province *

Postal code *

Phone *

Alternate phone

Email *

Confirm email *

Are you fluent in English? *

Yes

Are you fluent speaking in a language other than English? *

Yes

If yes, please list:

Are you a municipal employee? *

Yes

Please list the business unit you are employed with:

Are you a member of a municipal board, commission or agency? *

Yes

Please list the municipal board, commission or agency you are a member of:

Which District do you live in? *

Election Position Preference *

Choose which position(s) you're interested in:

First Choice:

Second Choice:

Third Choice:

Previous Election Experience

Briefly describe your previous experience, or provide any other relevant information.

If you have questions or need assistance with the filling of this form, please contact the Election Office.