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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:
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A board/commission must be selected.
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If interested in a specific position, please select one:
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Basic Information
Prefix:
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First Name:
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Middle Name:
Last Name:
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Suffix:
Preferred Name:
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Are you already a member of this board?:
Check if Yes
Home Address
Address Line 1:
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Address Line 2:
City:
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State:
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Zip Code:
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County:
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This is my mailing address:
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Mailing Address
Address Line 1:
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Address Line 2:
City:
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State:
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Zip Code:
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County:
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Contact Information
Email Address:
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Work Phone Number:
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Mobile Phone Number:
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Home Phone Number:
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Preferred Number:
*
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Education
High School:
*
School Name
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Graduated
No
Yes
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Year Graduated
College:
College Name
Graduated
No
Yes
Year Graduated
Degree
Post Graduate:
College Name
Graduated
No
Yes
Year Graduated
Degree
Employment Status
Employer:
*
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Job Title:
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Please provide your current employment status:
*
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Address Line 1:
Address Line 2:
City:
State:
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Zip Code:
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County:
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Phone Number:
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Fax Number:
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Email Address:
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Employment Date:
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December 2024
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Contact Person:
Contact Phone:
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Professional Licenses held (if applicable):
References
Reference 1:
Name
Title
Organization
Relationship
Phone Number
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Email
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Reference 2:
Name
Title
Organization
Relationship
Phone Number
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Email
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Reference 3:
Name
Title
Organization
Relationship
Phone Number
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Email
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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
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Race/Ethnicity:
*
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Are you a citizen of the United States?:
*
No
Yes
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Birth Date:
*
December 2024
Sun
Mon
Tue
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Sat
49
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Today
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Date of birth is required.
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Are you registered to vote in the state of North Carolina?:
*
No
Yes
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Attachments
Browse and Upload a Resume or Bio (Make sure to click 'Upload File Now' to upload):
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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.)
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