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["*姓名","*身分證統號(第一個字母請大寫)","*出生年月日(民國，請打8碼+斜線，如：55/01/01)","性別(填男/女)","本職機關(請全銜，如桃園市中壢區元生國民小學/非公教請填寫「社會人士」或「大專院校學生」)","本職職稱(如學校行政人員，請帶單位別，如人事室主任/非公教請填寫「社會人士」或「大專院校學生」)","*戶籍地址(縣市，如：桃園市)","*戶籍地址(鄉鎮市區，如：中壢區)","*戶籍地址(里，如：金華里)","*戶籍地址(鄰，寫數字即可，如：22)","*戶籍地址(請寫完整路名，如：環北路380號4樓)","通訊地址(縣市，如：桃園市)","通訊地址(鄉鎮市區，如：中壢區)","通訊地址(里，如：金華里)","通訊地址(鄰，寫數字即可，如：22)","通訊地址(請寫完整路名，如：環北路380號4樓)","指定之投票所開票所編號(請依本所提供分配表，填寫數字)","意願投開票所編號","未抽中指定之投票所開票所時，是否願意接受選舉委員會另行指定","投開票所職稱 ","選務經驗","本職職等","推薦來源","推薦政黨","推薦者(請填寫單位簡稱即可，如元生國小、新明國中...)","*選舉人身份別","*是否公教人員","同意擔任監察員並簽章切結確實無說明一不得擔任監察員之情事","行動電話(請統一格式為：0912-089555)","電話(公)(請統一前面加區碼，並用「-」表示分機，如：03-4271801-4357)","電話(宅)(請統一前面加區碼，如03-4271801)","已完成三劑(或以上)Covid-19疫苗接種(請填是/否)","備註(請備註葷/素)"]
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