EmailMe Form - Boards & Commissions Request for Appointment

Thank you for you interest in appointment to a Board or Commission in the Lujan Grisham Administration. Please complete the following information and submit it along with the supporting material.

Name *

First Last

Have you ever used a different name for school or employment?

First Last

Specific Board/Commission you are applying for:

Explain why you are applying for this position:

Contact Phone # *

### - ### - ####

Email *

Do you have a valid driver's license?

Yes

No

Upload Your Resume *

PDF Documents Only

Do you have any financial or other interests that might present a conflict of interest if you were to be appointed to the position for which you have applied? If yes, please explain in the space below. *

Yes

No

Have you at any time been a registered lobbyist? If so, please list the principals you represented and the dates. *

Yes

No

Have you ever been found guilty of any criminal law or a traffic violation for which you were fined more than $100? If yes, please explain in the space below. *

Yes

No

Are you currently involved, or have you been involved in the past five (5) years in a civil suit? *

Yes

No

Are you related to an employee of the State Agency at which you are seeking employment? *

Yes

No

Have you ever been accused of sexual harassment? *

Yes

No

If you answered "yes" to any of the questions above, please provide an explanation:

I hereby certify that this request contains no willful misrepresentation(s), and that should any investigation disclose such misrepresentation or falsification, my application will be rejected, my name removed from consideration for appointment, or I may be removed from appointment.

I understand that submission of my request does not guarantee appointment.

I understand that I may be required to submit to a background check as a condition of appointment. I understand that unsatisfactory results from, refusal to cooperate with, or any attempt to affect the result of these checks will result in withdrawal of any offer or termination of appointment.

By submitting this request I acknowledge that I have read and understand the above statements.