CDHS Boards and Commissions Application

CDHS Boards and Commissions Position Application

Do you want to serve on a CDHS-based board or commission? To apply, please fill in your details below.
Board or commission you wish to join*
Position in which you wish to serve*
First name*
Last name*
County*
Congressional district*
State Senate district
State House district
Email address*
Home address*
City, state, ZIP*
Date of birth*
Driver's license #
Gender*

MFPrefer not to answer
Registered voter?*

YesNo
Affiliation*

DemocratRepublicanOtherUnaffiliated
Race / ethnicity*

African-AmericanAsian / Pacific IslanderHispanicCaucasianNative AmericanOtherPrefer not to answer
Present employer / occupation*
Business phone*
Business address
Home phone*
Education (please attach resume or additional comments)*
Special skills, qualifications and relevant work, volunteer or life experience
List two people, not related to you, who you have known for at least one year, who could recommend you for this position.
Reference 1 - Full name*
Reference 1 - Phone*
Reference 1 - Email*
Reference 2 - Full name*
Reference 2 - Phone*
Reference 2 - Email*
Letters of reference / support

Upload a File

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Have you ever been a party to or the subject of or otherwise involved in any legal proceeding that might adversely affect your qualifications to serve on this board or commission?*

YesNo
If you answered yes to either of the two questions above, please explain in attachment to this application.

Upload a File

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Please explain why you wish to serve on a board or commission.
Additional information
Upload your CV or resume here*

Upload a File

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Other testmonials (e.g. certificates)

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I certify that the facts contained in this application are true and correct to the best of my knowledge. I authorize investigation of all statements contained herein and the references listed to obtain any and all pertinent information, personal and otherwise. I further authorize the Colorado Department of Human Services to conduct a criminal background check, including a criminal history from the Colorado Bureau of Investigation and a CDHS check for confirmed cases of child abuse or neglect. I release all parties for all liability for any damage that may result from furnishing such information. I understand the Colorado Open Records Act may require that certain information contained in this application be available for inspection by the public. TYPE FULL NAME TO ELECTRONICALLY SIGN*
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CDHS Boards and Commissions Position Application