Election System of the Virgin Islands 
Sunny Isle Shopping Center, Christiansted, St. Croix, V.I. (340) 773-1021 
Crystal Gade, St. Thomas, V.I. (340) 774-3107 
 
P.O. Box 1499  Kingshill  St. Croix  U.S. Virgin Islands 00851 / P.O. Box 6038  St. Thomas  U. S. Virgin Islands 00801 
 
 
APPLICATION FOR ELECTION OFFICERS 
PERSONAL INFORMATION 
 
 
NAME: ____________________________________________________________ 
 
PHYSICAL ADDRESS: ________________________________________________ 
 
MAILING ADDRESS: __________________________________________________ 
 
E-MAIL ADDRESS: ___________________________________________________ 
 
TELEPHONE #: ____________  Work ______________ Home ______________ Cell 
 
DATE OF BIRTH: _________________     SOCIAL SECURITY #: _______________ 
 
GOVERNMENT EMPLOYEE NUMBER: _________________ 
 
ARE YOU A REGISTERED VOTER?    _____ YES _____ NO 
 
PARTY AFFILIATION:     DEMOCRAT      REPUBLICAN       ICM      NO PARTY 
 
POLLING PLACE IN THAT YOU ARE REGISTERED: _________________________ 
 
WHAT LANGUAGE ARE YOU FLUENT IN: __________________________________ 
 
LIST PREVIOUS EXPERIENCE AS ELECTION OFFICERS OR YOUR PRESENT 
WORK HISTORY POSITION TITLES AND DUTIES: 
 
_____________________________________________________________________ 
 
_____________________________________________________________________ 
 
_____________________________________________________________________  
 
 
I, certify that the information given above is correct and true to the best of my knowledge. 
 
 
 
__________________________  
___________________________ 
Date 
Signature  
 
 
 
 
ELECTION SYSTEMS OF THE VIRGIN ISLANDS FORM 0020-REVISED 2010 
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