State of Michigan Election Inspector Application (Complete iny your own handwriting andr returnt toy your local City/Township Clerk)  personal information Full Name Date of Birth Home Address Phone #'s Home: County of  Email Address Work:  Cell: Pct#  Registered in 0 City or Township of  Ward#  Political Party Affiliation (REQUIRED; must be a recognized: state party & may not bel Independent): J Republican a Democratic a Libertarian Ou.s.Taxpayers OGreen Natural Law  Have you ever been convicted of ai felony or election crime? education and experience information Education Background (include highest grade completed or degree held)  Yes D No  Employment Background (include current or last place of employment and type or work performed)  Languages other than English that you: speak (ifany).  Please rate your computer experience (data look-up, database processing, creating pdfs, etc.):  1=r not experienced, 5= very experienced 01 02 03 04 05  Past experience as an election inspector, if any (include name ofj jurisdiction)  Do youl have transportation? signature and certification  Yes a No  Willy you work at any polling place? a Yes a No Ifnot, explain:  ICERTIFY THATIam not a member or al known active advocate* ofap political party other than the party identified above. IFURTHER CERTIFYTHAT the foregoing statements are true to the best of my knowledge and belief.  Signature of Applicant  Date  *A" "known active advocate" of another political partyi is definedt tor mean ap persony who1 1) is a delegate tot the convention ora an officer of another party; 2) is affliatedy with another party through ane elected or appointed government position or; 3) has made documented public statements specifically supporting by namea anotherp political party ori its candidates int thes same calendar year as the election atv which the person wills serve asa ani inspector. "Documented publics statements" means statements reported by the news media orv writtens statements ANY FALSE STATEMENTS MADE ON THIS APPLICATION WILL DISQUALIFY THE APPLICANT.  with a clear and unambiguous attribution tot the applicant. Approved by State Director of Elections (June 2015)