All fields marked with a red asterisk must be completed to submit the form.

PERSONAL INFORMATION
* LAST NAME: UNIT:
* FIRST NAME: * HOUSE NUMBER:
* CELL PHONE:
* STREET / AVENUE NAME:
ALTERNATE PHONE:
* QUADRANT:
* EMAIL ADDRESS: * CITY:
* POSTAL CODE:
EMERGENCY CONTACT INFORMATION
* NAME: * PHONE:
* RELATIONSHIP:
* Have you previously worked a census?
If yes: provide year, position, and location
* Are you able to read and understand maps of addresses in Edmonton?
* Are you able to meet the physical demands of the position (requires walking, climbing stairs, enumerating many residences in a short period of time)
* Are you fluent in English?
* Are you fluent in any other languages?
* How would you rate your ability and expertise with mobile devices (e.g.: tablets, iPads, smartphones)?
* Are you able to work flexible hours (e.g.: days, evenings, weekends) from April 22, 2019 to May 20, 2019?
* Are you able to work full time or part time for the census?
* Are you willing to work in any area of the City (excluding remote/rural/partially industrial areas)?
(Every effort is made to accommodate zone requests; however, please note you may be asked to work a census collection zone outside of your preferred area)
* Are you willing to work in remote/rural/partially industrial areas of the City? (vehicle and valid insurance required)
* Can the Elections and Census Office retain your personal information for future censuses?
* Can the Elections and Census Office retain your personal information for future elections?
* Have you ever been convicted of a criminal offence for which a pardon has not been received?
* I agree to attend mandatory training
(ALL census workers are required to attend a training session. Training sessions are held at the Elections and Census Office at 16304-114 Ave NW)
* I am 18 years of age or older, and legally entitled to work in Canada
* I understand that I am responsible for my own transportation for the purposes of collecting census data in my assigned collection zone.
* I understand that the City of Edmonton will NOT issue me a tax reporting document, such as a T4 slip
* I understand that it is my responsibility to report any compensation I receive for my census work for income tax purposes
* I understand that I am required to complete an additional Census Worker Questionnaire, in person.
* Once my application has been approved, I agree to apply for a Police Information Check as instructed
I certify that all statements made in this application are true and correct to the best of my knowledge. I understand that my employment as a census worker may be terminated without notice or compensation if it is determined that I have made any false or misleading statements in this application, or after my appointment as a census worker. I authorize the City of Edmonton to verify all statements contained in this application.
* Signature (type your first and last name):
* Verification Code:
The personal information on this form is being collected and used for selection and hiring, zone assignment, identification, remuneration, and future census or election worker opportunities, and is authorized under Section 33(C) of the Freedom of Information and Protection of Privacy Act. If you have any questions concerning the collection of this personal information, please contact the Director, Elections & Census, at (780) 496-8008, 16304 - 114 Avenue NW, Edmonton.