Submit an Application

Why this information is collected?

As a resident of Illinois, you are invited to use the form below to nominate yourself for membership on Illinois boards, commissions, committees, councils, and task forces. The information collected will be used by the Governor's Office in considering your interest and qualifications for appointment. If you have problems completing the form, please email gov.appointments@illinois.gov

The Governor's Office does not discriminate on the basis of sex, race, color, religion, gender identity, sexual orientation, national origin, age, military or veteran status, disability or any other characteristic protected by law. The demographic information collected will not be used in a discriminatory manner.

Per 15 ILCS 50/25, the Office of Gubernatorial Appointments is required to collect demographic information on applicants and appointed members. As such, the demographic information you may choose to provide will be utilized for this express purpose, and it will be kept confidential and protected from disclosure to the extent permitted by law. Your participation is completely voluntary.

* Required Fields. Please provide accurate information in ALL required fields.

Application for Gubernatorial Appointment

Part A: Board or Commission Sought

Board Name

Are you submitting this application to be considered for reappointment?

PART B: Basic Information

First Name

Middle Name

Last Name

Preferred Pronouns

Other Pronoun

Preferred Salutation

Other Salutation

Other Name Choice

Other Name

Spouse/Domestic Partner

Home Address

Home City

Home State

Home Postal Code

Email Address

e-Newsletter Subscription

Home Phone

Work Phone

Cellular Phone

Business Address

Business City

Business State

Business Postal Code

PART C: Demographic Information

Nominee Gender

Transgender

Sexual Orientation

Ethnicity

Asian (A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.)
African American (not of Hispanic Origin. A person having origins in any of the black racial groups of Africa.)
Hispanic (A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish Culture or origin, regardless of race.)
Middle Eastern or North African (A person having origins in any of the countries or territories of the Middle East or Northern Africa.)
Native American (A person having origins in any of the original peoples of North America, and who maintains cultural identification through tribal affiliation or community.)
Native Hawaiian or Other Pacific Islander (A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.)
White (not of Hispanic Origin. A person having origins in any of the original peoples of Europe, North Africa or the Middle East.)
Other/Not Specified Above (A person having an origins not included in the list above.)

Disability Choice

Disability

Veteran Choice

Veteran Branch or Component

Veteran Date of Service

Veteran Date of Discharge

Under State law, certain boards and commissions are required to have diversity of membership based on political affiliation. If you are applying for a position on such a board or commission and would like to furnish your political affiliation (if any) to the Office of Executive Appointments for inclusion in your application, please do so here.

Registered Voter

Registered County

Registered Party

Registered Other

Please Note: If you are unsure as to your party affiliation please visit Election Authorities page and find your County Clerk. They will be able to provide this information.

Date of Birth

Place of Birth

PART D: Education

High School Name

High School Location

Post Secondary Education

PART E: Employment and Professional Qualifications

Work Experience

Professional Licenses and Certificates

PART F: Government Affiliations and Experience

Public Official Choice

Public Official

Spouse Public Official Choice

Spouse Public Official

Lobbyist Choice

NOTE: The Illinois Ethics Act restricts registered lobbyists from serving on certain boards. Please review (25 ILCS 170/3.1) to determine your eligibility.

Spouse Lobbyist Choice

Government Employee Choice

Government Employee

Spouse Government Employee Choice

Spouse Government Employee

Governmental Pension Benefits Choice

Government Pension Benefit Entit(ies)

Governmental Pension Benefit Date

Governmental Pension Value

PART G: Interest and Qualifications

Interest

Unique Qualifications and Experiences

PART H: Certification

I agree with this statement below.

By clicking the "Submit" button below I hereby certify that the foregoing responses are true, accurate and complete. I agree that any misstatement, misrepresentation, or omission of fact may result in my immediate disqualification for appointment. I authorize the State of Illinois to review my credit and criminal history, and/or to request more information about my background. I further certify that I have read the Revolving Door provisions of the Illinois Ethics Act and if appointed, I agree to abide by them.

PART I: Attachments

Feel free to attach a personal resume