Application Form

Please fill out the following form to apply for a board.

If you are experiencing problems submitting this form, please download and fill out the application form below and email the completed version, along with a copy of your resume or bio to boardsandcommissions@nc.gov

Click here to download the form.

Select a Board/Commission

Please select the board you would like to apply for:*

If interested in a specific position, please select one:

Basic Information

Prefix:*

First Name:*

Invalid value

Middle Name:

Last Name:*

Invalid value

Suffix:

Preferred Name:*

Invalid value

Are you already a member of this board?:

Check if Yes

Home Address

Address Line 1:*

Invalid value

Address Line 2:

City:*

Invalid value

State:*

Invalid value

Zip Code:*

Invalid value

County:*

Invalid value

This is my mailing address:

Check if Yes

Mailing Address

Address Line 1:*

Invalid value

Address Line 2:

City:*

Invalid value

State:*

Invalid value

Zip Code:*

Invalid value

County:*

Invalid value

Contact Information

Email Address:*

Invalid value

Work Phone Number:

Invalid value

Mobile Phone Number:

Invalid value

Home Phone Number:

Invalid value

Preferred Number:*

Invalid value

Education

High School:*

School Name

Invalid value

Graduated

Yes

Invalid value

Year Graduated

College:

College Name

Graduated

Yes

Year Graduated

Degree

Post Graduate:

College Name

Graduated

Yes

Year Graduated

Degree

Employment Status

Employer:*

Invalid value

Job Title:*

Invalid value

Please provide your current employment status:*

Invalid value

Address Line 1:

Address Line 2:

City:

State:

Zip Code:

Invalid value

County:

Phone Number:

Invalid value

Fax Number:

Invalid value

Email Address:

Invalid value

Employment Date:

Contact Person:

Contact Phone:

Invalid value

Professional Licenses held (if applicable):

References

Reference 1:

Name

Title

Organization

Relationship

Phone Number

Invalid value

Reference 2:

Name

Title

Organization

Relationship

Phone Number

Invalid value

Reference 3:

Name

Title

Organization

Relationship

Phone Number

Invalid value

Previous employment or experience:

Memberships in professional, civic organizations or government boards or commissions:

Community Service / Volunteer Activities:

Could you or your family be affected financially by decisions made by the board or commission for which you are applying?:

Yes

If yes please explain:

Have you been a registered lobbyist or have you employed a lobbyist at any time during the past five years?:

Yes

Board or commission meetings are held during the day. Are you able to come prepared and actively participate in day meetings?:

Yes

Why do you want to serve on this board or commission?:

Personal Information

Gender:*

Male

Female

Invalid value

Race/Ethnicity:*

Invalid value

Are you a citizen of the United States?:*

Yes

Invalid value

Birth Date:*

Are you registered to vote in the state of North Carolina?:*

Yes

Invalid value

Have you ever been convicted of or found to have committed a crime or offense? (Do not include traffic offenses for which the fine was less than $200.00):*

Yes

Invalid value

If Yes, please explain:

Attachments

Browse and Upload a Resume or Bio (Make sure to click 'Upload File Now' to upload):*

Browse...

Upload File Now

Remove

Uploaded files

I certify that I have given true, accurate and complete information on this form to the best of my knowledge. I authorize the Governor’s Office to investigate any and all statements made in this application and understand that false information or documentation, or a failure to disclose relevant information may be grounds for rejection of my application. I further understand that dismissal upon appointment shall be mandatory if fraudulent disclosures are given to meet position qualifications (Authority: G.S. 14-122.1.)

Please check if you agree with the above statement:*

Invalid value

Submit

Jan	Feb	Mar	Apr
May	Jun	Jul	Aug
Sep	Oct	Nov	Dec