Commissioner-in-Charge Certification Form

First Name*

Last Name*

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone

Cell Phone

Work Phone

Email*

Registered to Vote in Ward/Precinct:

Party Affiliation:*

Emergency Contact Name*

Emergency Contact Phone*

Confirmation

By clicking Submit, I certify that I am a registered voter in the Ward in which I am seeking to serve; I am NOT a candidate for election to public office; I have NOT been convicted of an election offense; I am able to perform the essential duties of a commissioner-in-charge described on Pg. 79 in the Informational Pamphlet by the Secretary of State pursuant to R.S. 18:421(C); I watched the training video in its entirety; and that the information herein is True and Correct.

1. If the name of a qualified voter was omitted from the precinct register, or supplemental precinct register, the commissioner shall:*

2. In identifying a voter prior to voting, a commissioner shall first request:*

3. If a voter arrives without any form of photo identification, a commissioner shall:*

4. One of the three grounds for challenging a person applying to vote is:*

5. Prior to serving at the polling place, a watcher must:*

6. If there is a problem with a voting machine, the commissioners shall:*

7. No political activity is allowed between the hours of 6:00 a.m. and 9:00 p.m. on election day in the following location(s):*

8. Who compares the numbers on the seals and public and protective counters of each voting machine with the numbers on the envelope containing the keys and/or seals to the voting machines?*

9. Who may challenge a voter as not eligible to vote in the election?*

10. According to law, who shall be allowed to go to the front of the line to cast a ballot at the polls?*

11. For what elected offices are voters allowed to cast a provisional ballot?*

12. If a commissioner fails to appear at the polling place before the opening of the polls on election day, the commissioner-in-charge shall:*

13. If on the signature line next to a voter's name there is "ADDRESS CONFIRMATION REQ." and the voter has not voted absentee, which form must be completed?*

14. The Clerk of Court Clear Zipper Bag should contain:*

15. Which answer does NOT apply in determining whether to allow a voter to receive assistance in voting?*

16. A person marked on the precinct register as "Voted by Mail":*

17. The name of every person who votes at the polling place shall be entered on the poll lists that are kept separate from the precinct register:*

18. Who receives the sealed envelope containing the keys and/or seals to the voting machines?*

19. The commissioner-in-charge shall administer the oath to the commissioners:*

20. The documents required to be posted, shall be posted:*

Name

This field is for validation purposes and should be left unchanged.

Annette M. Fontana

Commissioner-in-Charge Certification Form

Commissioner-in-Charge Certification test 2

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