LAvote.net

Apply Online at LAvote.net

Phone: 562-347-2444 Email: eoc@rrcc.lacounty.gov

Get Paid Sooner Less Paperwork

Registered Voters Get Hired on the Spot

Work With Your Friends & Family

3-Day CIC Loading Assistant earns up to $5751-Day CIC Loading Assistant earns up to $195

CIC LOADING ASSISTANT

Check-In-Center Staff Application Please print clearly

(Required)

Legal Name:

First Middle Initial Last .

Home Address: .

City: Zip Code: .

Home Phone: .

Cell or Alternate Phone: .

Email address: .

Date of Birth: Month Day Year .

Driver’s License Number: (To confirm voter registration)

Social Security Number: - - (For tax purpose)

(Optional)

Mailing Address (If Different from Home Address)

Address: .

City: Zip Code: .

Office Phone: .

Fax Number: .

Work Address: .

City: Zip Code: .

Have you served as a CIC Loading Assistant (Swamper) before? Yes ☐ No ☐ If so, do you have a preferred driver to work with? . Are you an employee of Los Angeles County? Yes ☐ No ☐ If yes, what department?: .

You are not eligible to serve if you or a family member is a candidate for this election. Individuals who are registered sex offenders cannot volunteer.

I certify that I am a Registered Voter in California ☐ or Legal Permanent Resident ☐ Not registered? Register online today at lavote.net or with the application provided by the Election Operations Center.

I understand that Inspector Supply Pick-Up begins by reporting at 4:30 am and may last until approximately 8 pm. ☐ I understand that Check-In-Center operations begin by reporting at 3 pm and may last until approximately 4 am. ☐

Signature Required: .

Mail completed application to:

Los Angeles County Registrar-Recorder/County Clerk Attn: Election Operations Center

12680 Corral Pl. Santa Fe Springs, CA 90670

Or Email to: eoc@rrcc.lacounty.gov Or Fax to: (562) 946-8751

Questions? Call (562) 347-2444

For RR/CC office use only:

Worker ID#: .

Assigned Position: ☐ 1 Day ☐ 3 Day

Date: .

Staff Initials: .