Boards & Commissions Application

APPLICANT DETAILS

Board or Commission you are applying for

Board ID

Board or Commission you are applying for:

Please tell us which mode group(s) you are interested in:

Bicycle RiderPedestrianTransit RiderVehicle DriverOther Mobility System User

Salutation

First Name

Middle Name

Last Name

Applicant Home Address

Street Address

City

State

Zip

County

CONTACT DETAILS

Primary Phone

Other Phone

Primary E-mail Address

Other Email Address

Are you a registered voter?

YesNo

If so, what county?

Denver City Council District No.

Date of Birth

Ethnicity: Are you of Hispanic or Latino origin or descent?

Race

Other Ethnicity

Gender

Other Gender

EMPLOYMENT INFORMATION

Employer

Position

Employer Phone #

Work Email

Street Address

City

State

Zip

Education and General Qualifications

High School

Name of High School

Location

# of years attended

Did you Graduate?

College

Name of College

Location

# of year attended

Did you Graduate?

Major

Graduate School

Name of Graduate School or Trade/ Business/ Correspondence

Location

# of years attended

Did you Graduate?

Major

References

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

Reference 1

Name

Phone

Address

Reference 2

Name

Phone

Address

Reference 3

Name

Phone

Address

Special Information

Is there anything that would adversely affect public confidence in your appointment or service?

YesNo

If yes, please explain

Are you a registered lobbyist?

YesNo

Would your professional responsibilities pose a conflict of interest with your intended role on this board or commission?

YesNo

Have you served on another Denver board or commission?

YesNo

Please select other Denver Boards or commisions you've served on:

Add multiple attachments such as Resume, Biography, Headshot/Photo here:

Resume and headshot/photo are required

By submitting this application and checking this box, you are authorizing the Mayor's Office of Boards and Commissions to run a background check.

By submitting this application and checking this box, you acknowledge that you understand that the Colorado Open Records Act may require that certain information contained in this application be available for inspection by the general public.

Contact Information