Board and Commission Public Application Form

Thank you for your interest in a public appointment by the Vermont Speaker of the House.

Speaker Jill Krowinski and her staff will process your application and contact you if necessary.

Questions about the public appointment application can be directed to: ckennedy@leg.state.vt.us

Board/Commission Public Application Form

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Vermont Commission on Women (VCW) is an independent non-partisan state government commission working to advance rights and opportunities for women and girls in Vermont. You can view their website here.

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Name

Email

Phone

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Date of Birth

Town of Residence

Year Round Resident?

Background/Experience

The Speaker is seeking to appoint individuals from around the State and from diverse racial, ethnic, religious, age, sexual orientation, and socioeconomic backgrounds. The Speaker is also seeking a diversity of expertise related to the mission of the board/commission, including lived experience, volunteer experience, professional experience, and technical/academic experience. Applicants with non-traditional work and career paths are encouraged to apply for any appointment where they believe they would excel.

Ideal candidates will have experience working with a diverse group of partners toward a shared goal, be solutions-oriented problem solvers, have excellent critical-thinking skills, and will serve as connectors between their communities/networks and the work of the board/commission.

Brief Bio/Resume:

Why do you want to serve on the Commission/Council? (500 word limit)

Please list two persons unrelated to you that we can contact as a reference for your appointment:

(1) Reference Contact Information (Name, phone number, email address):

(2) Reference Contact Information (Name, phone number, email address):

Is there anything else you think we should know about you, your background, or experiences?

Diversity

The following information is elicited in order to ensure that the Speaker considers the talent and creativity of a diverse pool of candidates. In addition, specific backgrounds for qualifications are legally required for appointment to some boards and commissions.

Race/Ethnicity

Gender

Age

Military Service

Person with Disability

Conflict of Interest

The following information is intended to promote transparency, and prevent possible conflicts of interest between appointees and the boards and commissions on which they serve. If a question doesn’t apply to you, please answer “no”.

Current Employer

Have you ever been elected or appointed to public office (including other boards or commissions)?

If you answered yes, please list the public office, board, or commission.

Please list association memberships:

Have you held or do you hold an occupational or professional license or certificate in the State of Vermont or any other state?

If you answered yes, please list the licenses or certificates.

Have you been, or are you now, a registered lobbyist?

Have you or members of your immediate family or businesses in which you or they have been an owner, officer, or employee, had any contractual or other direct dealings during the last 4 years with any government agency?

If you are applying for a public member slot on a licensing board, have you or members of your immediate family been a member of this profession or associated professions?

Office of the Speaker

115 State Street Montpelier, VT 05633

(802) 828-2245

Speaker@leg.state.vt.us