Board & Commission On-Line Application

Please complete all required fields

General Information

Board/Commission and seat you are seeking:Required

For example: Pick: Board of Agriculture, then type "Public Seat"

Additional Boards/Commissions of interest:Required

State Boards/Commissions on which you have servedRequired

List all seats including all current or past service or "None" if applicable.

First & Middle Names Required

Last Name  Required

Home/Message Phone  Required

Business Phone

Cell Phone

Mailing Address Required

City

State & ZIP

Email Address  Required

Are you a registered voter?

You must be a registered voter to apply.

Have you ever been convicted of a misdemeanor within the past five years or
a felony within the past ten years?

Required

Conviction Circumstances Required

Please explain the circumstances. A conviction is not necessarily grounds for disqualification.


Conflict of Interest

Certain boards and commissions require full disclosure of personal financial data under AS 39.50.010.
If required for the board or commission for which you are applying, are you willing to do so?

Required

Could you or any member of your family be affected financially by decisions to be made
by the board or commission for which you are applying?

Required

Please explain the potential financial benefit Required

Please explain the financial implications for your or your family by action of the board or commission to which you are applying.


Training, Experience & Qualifications

List any professional licenses, certifications, or registrations and dates
obtained that may be used as qualifying criteria: Required

List both formal and informal education and training experiences: Required

List any community service, municipal government, and state positions held,
and any awards received.Required

Include both compensated and uncompensated positions (such as president of a service organization or a mayor).
Include length of time serviced.

Employment work history including paid, unpaid or voluntary.Required

The Office of the Governor and the State of Alaska have an Affirmative Action Equal Employment Opportunity Program. To assist in the program, you are asked to voluntarily answer the following questions to provide the information necessary for reporting purposes. Under State and Federal law, the information you provide will not be used to illegally discriminate against you.

Date of Birth

Gender

Military Service

If applicable, provide dates of services

Ethnicity

American Indian/Native...
Alaskan Native
Asian or Pacific Islander...
African American
Hispanic
White
Decline to self-identify

Certification of Accuracy & Completeness
By submitting this online application, I swear the information I have entered on this form is true to the best of my knowledge. I understand that if I deliberately conceal or enter false information on the form my application may be rejected, I may be removed from the list of eligible candidates, or I may be removed from the position. I agree that the Office of the Governor may contact present or former employees or other persons who know me to obtain an additional information about my skills and abilities. I understand that the information on this application is public information and may be released through a legal request for such information.

Type "I certify"Required


Your IP address is:

107.22.127.92

Resumé Addendum

You may paste your resumé here if desired.

Press Release Wording

If appointed, a press release will be issued announcing your appointment pending the completion of the appointment process with the Governor's office. Please provide the following information so it may be included in the press release.

Example #1: John A. Doe, 38 of Soldotna, is Director of T-Shirts & Co. Doe holds a bachelor's degree in business
administration from X University and a master's degree in communications from X University.

Example #2: John A. Doe, 38 of Palmer, is the owner and operator of Doe and Associates, Inc. Doe previously served
as division manager at X, Inc. Doe is a certified personnel consultant.