Application Form

BOARDS AND COMMISSIONS APPLICATION

 

Please complete the following information in full,

attach a cover letter, current resume or biography and return to the address below.

 

Type or print in blue or black ink.

 

Board or Commission you are applying for:____________________________________________

 

Last Name: ____________________________ First Name: ____________________________

 

Occupation/Employer: __________________________________________________________

 

Work Address: ________________________________ City: ____________Zip: ___________

 

Work E-mail Address: ________________________________ __________________________

 

Work Phone: __________________________ Work/Home Fax: _________________________

 

Home Address:___________________________ City: _________________ Zip: ___________

 

Home Phone: ____________________________ Cell Phone/ Pager: ______________________

 

Home E-mail Address: __________________________________________________________

 

Are you a registered voter?     Yes     No            If so, what county? ________________________

Colorado ID or Driver's License Number:  ____________________________________________

Denver City Council District No.: __________              Ethnicity___________________________

 

Highest Level of Education or Degree Earned: ___________________ Year Completed: ______

 

Memberships/ Organizations/ Volunteer Activities (include past or present):

 

______________________________________________________________________________

 

______________________________________________________________________________

 

______________________________________________________________________________

 

References (List three persons, not related to you, whom you have known at least one year):

            Name                                       Address                                  Phone Number

 

______________________________________________________________________________

 

______________________________________________________________________________

 

______________________________________________________________________________

 

Special Information:

Is there anything that would adversely affect public confidence in your appointment or service?  Yes    No

If yes, please explain on a separate sheet of paper.

 

                                                       _______________________________________

                                                                  Signature                                                     Date

Return Completed Form to:

Anthony Aragon, Director of Boards and Commissions

City and County of Denver Building, Room 350

Denver, CO  80202   Phone: (720) 865-9032     Fax: (720) 865-8787

 

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