General Information |
Board/Commission and seat you are seeking:Required
For example: Pick: Board of Agriculture, then type "Public Seat"
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Additional Boards/Commissions of interest:Required
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State Boards/Commissions on which you have servedRequired
List all seats including all current or past service or "None" if applicable.
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First & Middle Names Required
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Last Name Required
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Home/Message Phone Required
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Business Phone
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Cell Phone
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Mailing Address Required
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City
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State & ZIP
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Email Address Required
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Are you a registered voter?
You must be a registered voter to apply.
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Have you ever been convicted of a misdemeanor within the past
five years or
a felony within the past ten years?
Required
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Conviction Circumstances Required
Please explain the circumstances. A conviction is not necessarily grounds for disqualification.
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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
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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
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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.
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Training, Experience & Qualifications |
List any professional licenses, certifications, or registrations and dates
obtained that may be used as qualifying criteria: Required
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List both formal and informal education and training experiences: Required
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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.
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Employment work history including paid, unpaid or voluntary.Required
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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.
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Certification of Accuracy & Completeness |
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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.
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Type "I certify"Required
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Your IP address is:
38.107.191.98
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Resumé Addendum
You may paste your resumé here if desired.
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Press Release Wording
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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.
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