Boards and Commissions Application Logging
System Information 
Logging Type:
Logging Item:
Create Date:
  • Note: Complete fields as appropriate below. This is one of two screens. After clicking the SAVE button, you will have an opportunity to attach additional files to this application. Resumes should be in PDF, DOC, or RTF format.
  • A resume or brief biography is required as part of this application. Have this ready to attach at the completion of this application process.
  • At this time, you cannot return to complete this document at a later date.
Title (Mr. Ms. Mrs.)
First Name
Middle Init.
Last Name
Zip Code
Congressional District
Resident Phone
Mobile Phone
Email Address
Birth Date (mm/dd/yyyy)
Current Employer
Business Address
Business City
Business State
Business Zip Code
Business Phone
Business Fax
Spouse's Name
Spouse's Employer
  • This information is necessary for certain boards in regard to racial and/or political balance. These elements are defined by statute for each board.
Party Affiliation
Education and General Qualifications
Did you Graduate High School?  
High School
No. Years Attended HS
Did you attend College?  
Name of College/Other
Major Course of study
Minor Course of Study (option)
No. Years Attended
Did you Graduate from College with a degree?  
  • Include memberships and positions in organizations or political parties. Indicate any public office held.
Membership in Organization 1
Membership in Organization 2
Membership in Organization 3
Have you ever been conficted of a Felony?  
If yes then Comment
Reference Name 1
Reference Address 1
Reference Phone Number 1
Reference Years Acquainted 1
Reference Name 2
Reference Address 2
Reference Phone Number 2
Reference Years Acquainted 2
I attest that the information provided above is accurate as submitted  *
  • Click on the save button to continue and attach a resume/vitae.
Copyright © 2009 Commonwealth of Kentucky
All rights reserved.
CHFS Application Name