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ARIZONA GOVERNOR'S OFFICE APPLICATION
FOR BOARDS AND COMMISSIONS
The preferred method of applying for a Board or Commission is by completing the on-line application below. However, a paper application may be printed out, completed and sent by US Mail or scanned and e-mailed to bc@az.gov.
Application:
A current application and resume are required both for initial appointment or reappointment consideration.
Resume Required:
After completing and submitting the application below, a second window will give you the opportunity to submit your current resume which is required. You can also submit it at a later time to bc@az.gov; however, your application is not considered until a resume is received. Resumes are only accepted in Word or PDF format, pasted into an e-mail, or by hard copy mailed or hand delivered
Instructions for Letters of Recommendations:
The Governor’s Office welcomes and needs written assessments of the applicants' skills, expertise, ethics and any other characteristic relevant to an individual's potential for an appointment. Many applicants solicit letters of reference supporting their efforts at an appointment. However, applicants are advised "more" is not necessarily "better." The Governor’s Office would prefer to receive no more than 10 substantive e-mails regarding each applicant. The preferred means of communicating recommendations to the Governor’s Office is through e-mail. Please direct any such e-mails to bc@az.gov.
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a required entry. |
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| Title: |
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| First Name: * |
A value is required. Middle Initial:
Last: *
A value is required. |
| Spouse's
Name: |
Title:
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| Spouse's
Employer: |
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A value is required. |
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A value is required.State:*
A value is required.Invalid 5 digit Zip Code. |
| County: |
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Invalid phone format e.g. 6025422449
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| Business Name: |
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A value is required. |
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A value is required. State*
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A value is required.Invalid 5 digit Zip Code. |
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Invalid Phone format e.g. 6025422449
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| Email
Address: * |
A value is required.Invalid E-mail format. |
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| Correspondence Preference:
Office
Home |
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| Date of Birth: * |
A value is required.Invalid mm/dd/yyyy Date format. |
| Place
of Birth: |
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| In
the event you are selected for an interview
you will be required to provide your
social
security number. Staff will contact you
personally to obtain that information. |
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| Gender: * |
Male
Female |
| Ethnicity: |
African American |
Asian/Pacific Islander |
Caucasian |
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Latino |
Native American |
Other |
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No Response |
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| Party Registration: * |
A value is required. |
| Referred By: |
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List 3 Boards/Commissions of Interest: (List according to preference - do not use "Any")
(1) *
(2)
(3) |
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| Education:
(Including degrees completed) *
A value is required. |
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References: (Name,
Business/Company/Agency, Phone) Enter up to 3 references)
A value is required. |
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| Affirmation of Eligibility |
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In accordance with A.R.S. 38-201, every state officer shall not be less than eighteen years of age, a citizen of the United States and a resident of this state.
Do you meet these requirements?
If No, please explain:
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Are you currently charged with or have you ever been arrested for or convicted of any felony, misdemeanor, or violation of the Uniform Code of Military Code of Justice?
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Yes
No
If Yes, please explain:
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To your knowledge, has any formal charge of professional misconduct ever been filed against you by a licensing or regulatory board or by any other disciplinary body in any jurisdiction?
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Yes
No
If Yes, please explain:
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In the past five years, have you ever been reprimanded, demoted, disciplined, placed on probation, suspended, cautioned or terminated by an employer as a result of your alleged consumption or use of alcohol, prescription drugs or illegal drugs?
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Yes
No
If so, state the circumstances under which such action was taken and the background and resolution of such action.:
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Is there any possible conflict of interest, whether financial or personal, or other matter that would create problems or prevent you from fairly and impartially discharging your duties as an appointee?
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Yes
No
If Yes, please explain:
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Is there any information that, if it came to light, would embarrass you or reflect negatively on your appointment?
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Yes
No
If Yes, please explain:
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Optional: Governor's
Press Release Notification Signup:
No
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I
certify that the facts contained in this
application are true and correct to the best of my knowledge. I have reviewed the statutory
requirements governing the board/commissions in which I have expressed
an interest and
confirm that I meet those requirements. I authorize investigation
of all
statements contained herein and the references listed
above to give you any
and all information concerning my qualifications and
any pertinent information
they may have, personal or otherwise, and release all
parties from all liability
for any damages that may result from furnishing the same
to you. Entering my
name and the date below has the same legal ramifications
as a hand signed
document.
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*
A value is required.
*
A value is required.Invalid mm/dd/yyyy Date format. |
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Incorrect code! Please view the numbers in the verification code image above or listen to the audio code and try again. |
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| ERROR: Please review your responses and fill all required fields indicated on the form. |
Your rights to privacy are of utmost importance to the Governor's Office in building trust and confidence when conducting business through the Internet. The Governor's Office will attempt to protect the privacy interest of anyone who corresponds with the Governor's Office and does not wish their contact information to be made public; however, because the Governor's Office is a public entity, there can be no guarantee that such information will always be kept confidential.
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