North Carolina Office of the Governor - Boards and Commissions Information Sheet

North Carolina Boards and Commissions

Application / Recommendation Information Sheet

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Please take a moment to complete the following form, which will provide the necessary information to process your application. Note: Resume file must be attached when submitting this application. Click the BROWSE button to select the resume file from your hard-drive.
Resume Location:

Full Name:
Call Name:
Email Address:
Home Address:
Street:
City, State Zip Code:			, NC
Home Phone:
Work Address:
Street:
City, State Zip Code:			, NC
Work Phone:
County Congressional District:
Race:
Gender:
Have you ever been charged with or convicted of a criminal offense other than a minor traffic violation?
If 'yes' please explain:
Board or Commission: