I hereby state that I am willing to serve as a precinct election officer, have not failed to serve without excuse in the past, and have not been convicted of an election law offense or any felony, unless my civil rights have been restored by the Governor. I further state that I possess the required qualifications of an election officer belonging to the political party indicated above. I understand that if I am selected as a precinct officer, I am required by law to attend a training session conducted by the County Board of Elections.
The undersigned hereby certifies that the above have been selected and recommended as suitable persons from whom to appoint as precinct election officers for the precinct indicated above. I further certify that this list contains the statement required by KRS 117.045 that each person is willing to serve, has not failed to serve without excuse in the past, and has not been convicted of an election law offense or any felony, unless his civil rights have been restored by the Governor.
KRS 117.045(2); KRS 117.187(2); KRS 117.995; KRS 119.307