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The District of Columbia
dc
 
 
Application for Mayoral Appointment to a Board or Commission

Complete the form in full. Fields marked with * are required.
Allow for a three week processing time.
Provide draft language if applicable.

Requested By Outside U.S.  
Prefix * First Name Initial * Last Name Suffix
Address:
    
City:
State: Zip:
 Add an Additional Address
Home Phone:
Work Phone: Cell:
Work phone format: xxx-xxx-xxxx ext12345
Email:
 Add an Additional Email
  Organization:

Secondary Address(optional)
Address:
City:
State: Zip:
Phone:
Email:
Application for Appointment
* Board 1:
Board 2:
Board 3:
Other:
Personal Information
* Gender:
* Date of Birth:
* Ethnicity:





 
Diversity:
Education and general Qualification
* Did you Attend High Shool or receive a GED?
* Did you Attend a College or post-secondary education?
* Did you Attend a Graduate Postgraduate Program?
Licenses Held (if applicable):
Special Skills and Qualifications:
Community Activities/Organizational Affiliations(current):
Declarations
* Are you a citizen of the United States?
* Are you a Permanent Resident of the United States?
* Are you registered to vote in the District of Columbia?
* Are you a current employee of the U.S. government?
* Are you a current employee of the District government?
* Are you, or a family member, currently serving on board?
* Have you ever had a professional/occupational license revoked, or suspended, as a result of desciplinary action?
* Have you ever been convicted of, or pleaded guilty to, a crime?
* Is there anything in you background that might become an embarrassment to you if it were to become public?
Application Details
Comments:
Reference:
Resume:
(Optional)


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