Please Wait...
Home
Board & Commission Profiles
Recent Appointments
Apply
Recommend
Current Openings
Member Resources
Contact Us
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:
*
A board/commission must be selected.
Loading…
If interested in a specific position, please select one:
Loading…
Basic Information
Prefix:
*
Invalid value
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
Loading…
Zip Code:
*
Invalid value
County:
*
Invalid value
Loading…
This is my mailing address:
Check if Yes
Mailing Address
Address Line 1:
*
Invalid value
Address Line 2:
City:
*
Invalid value
State:
*
Invalid value
Loading…
Zip Code:
*
Invalid value
County:
*
Invalid value
Loading…
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
Loading…
Education
High School:
*
School Name
Invalid value
Graduated
No
Yes
Invalid value
Year Graduated
College:
College Name
Graduated
No
Yes
Year Graduated
Degree
Post Graduate:
College Name
Graduated
No
Yes
Year Graduated
Degree
Employment Status
Employer:
*
Invalid value
Job Title:
*
Invalid value
Please provide your current employment status:
*
Invalid value
Loading…
Address Line 1:
Address Line 2:
City:
State:
Loading…
Zip Code:
Invalid value
County:
Loading…
Phone Number:
Invalid value
Fax Number:
Invalid value
Email Address:
Invalid value
Employment Date:
Loading…
October 2024
Sun
Mon
Tue
Wed
Thu
Fri
Sat
40
29
30
1
2
3
4
5
41
6
7
8
9
10
11
12
42
13
14
15
16
17
18
19
43
20
21
22
23
24
25
26
44
27
28
29
30
31
1
2
45
3
4
5
6
7
8
9
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Today
Clear
Contact Person:
Contact Phone:
Invalid value
Professional Licenses held (if applicable):
References
Reference 1:
Name
Title
Organization
Relationship
Phone Number
Invalid value
Email
Invalid value
Reference 2:
Name
Title
Organization
Relationship
Phone Number
Invalid value
Email
Invalid value
Reference 3:
Name
Title
Organization
Relationship
Phone Number
Invalid value
Email
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?:
No
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?:
No
Yes
Board or commission meetings are held during the day. Are you able to come prepared and actively participate in day meetings?:
No
Yes
Why do you want to serve on this board or commission?:
Personal Information
Gender:
*
Male
Female
Invalid value
Race/Ethnicity:
*
Invalid value
Loading…
Are you a citizen of the United States?:
*
No
Yes
Invalid value
Birth Date:
*
October 2024
Sun
Mon
Tue
Wed
Thu
Fri
Sat
40
29
30
1
2
3
4
5
41
6
7
8
9
10
11
12
42
13
14
15
16
17
18
19
43
20
21
22
23
24
25
26
44
27
28
29
30
31
1
2
45
3
4
5
6
7
8
9
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Today
Clear
Date of birth is required.
Loading…
Are you registered to vote in the state of North Carolina?:
*
No
Yes
Invalid value
Attachments
Browse and Upload a Resume or Bio (Make sure to click 'Upload File Now' to upload):
*
Drop file(s) here
Browse...
Browse...
Upload File Now
0%
Cancel
Common error text is displayed here
Please use a browser with HTML5 support; or install
Microsoft Silverlight v3 or later
to view this content and have an ability to upload files.
Remove
Uploaded files
Error: Could not retrieve content with ID = ApplicationAgreement
Please check if you agree with the above statement:
*
Invalid value
Submit