Boards and Commissions Application

Boards and Commissions Application

This form must be completed in its entirety before it can be processed.

Use this form to submit an application to serve on a State of Hawai‘i board or commission under the Green-Luke Administration. Follow the instructions below to submit your resume and other information.

The Governor is responsible for appointing the members of over 180 boards and commissions that are established by the State Constitution, state statutes, or executive orders. The Governor's team is looking for exceptional individuals who are dedicated to advancing the Hawai‘i agenda to build a strong and sustainable economy, invest in Hawai‘i's people, and build stronger communities. We are looking for people who can work effectively with diverse communities, have excellent work skills, and are ready to face the challenges in Hawai‘i today.

The members of most of the State’s boards and commissions are unpaid volunteers. These boards and commissions include the Board of Land and Natural Resources, the Land Use Commission, the Stadium Authority, and the Aloha Tower Development Corporation. Read the List of Boards & Commissions.

People interested in applying should make every effort to submit all requested information for consideration.

If you have questions, please contact the Office of the Governor.

1Applicant Information > 2Sign & Submit
Legal Name * First Middle Last
Enter your legal first and last name.
Maiden or other names, including dates of use:
Please check preferred title: *
Mr. Miss Ms. Mrs. Dr. Other
U.S. Citizen *
Yes No
Residential Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Enter your residential address.
Mailing Address (if other than your residence)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Enter your mailing address (if other than your residence).
Island of Residence *
Residency in Hawai‘i (Years) *
Have You Lived in Hawaii For the Past 12 Months? *
Yes No
Name of Spouse
Daytime Phone: * - ### - ### ####
Enter your daytime phone #.
Evening Phone - ### - ### ####
Enter your evening phone #.
Mobile Phone - ### - ### ####
Enter your mobile phone #.
Primary Email Address *

Enter your email address.
Current Profession/Occupation *
Reference #1
Name First Last
Email
Phone - ### - ### ####
Reference #2
Name First Last
Email
Phone - ### - ### ####
Reference #3
Name First Last
Email
Phone - ### - ### ####
Are you currently serving on any board, commission, or council created by the State Constitution or a state statute?
If so, please state the name of the body and the date when your term expires.
Are you a member of a union? *
Yes No
If yes, please state the name of the union and union number
Conviction for a Crime (You DO NOT need to report: 1) Arrests not followed by convictions. 2) Convictions which were annulled or expunged)
Have you been convicted of a felony or misdemeanor? *
Yes No
Have you ever been convicted of any act, attempt or conspiracy to overthrow the state or the federal government by force or violence?
*
Yes No
If you answered “yes” to either question, indicate the date(s) and explain below: Date(s):
ATTACH YOUR LETTER OF INTEREST AND RESUME — Allowed file types are .pdf, .doc or .docx. Other file types are unacceptable.

Please name your files as follows:
firstname lastname interest.ext, (e.g., "john doe interest.doc")
and
firstname lastname resume.ext (e.g., "john doe resume.doc").
Please attach Letter of Interest: *

Please submit a summary of your qualifications and why you would like to serve on this/these board(s) or commission(s).
Please attach Resume: *
Indicate on which Commission(s) and/or Board(s) you would like to serve.
First choice board name *
Second choice board name
Third choice board name
If my choices are no longer available, I would still like to be contacted for another open position. (Please check the box if so.)
Check here if you are currently serving a state board, council, committee or commission and are reapplying to the same state board, council, committee for an additional term.
For Applications Completed With Assistance
The following individual read the foregoing Application Form, and the Acknowledgment and the Authorization, to me, and assisted me in completing this application. First Last
Acknowledgement of the State Ethics Commission Annual Disclosure of Financial Interests

Under the State Ethics Law, Hawaii Revised Statutes Ch. 84, members of state boards and commissions who are appointed to terms of more than one year and whose functions are not “solely advisory” must file a financial disclosure statement with the State Ethics Commission.

Statements, other than those of members of boards that head a state department as well as 15 boards and commissions affected by Act 230, Session Laws of Hawaii 2014 (Board of Regents of the University of Hawaii, Board of Directors of the Agribusiness Development Corporation, Board of Agriculture, State Ethics Commission, Hawaii Community Development Authority, Hawaiian Homes Commission, Board of Directors of the Hawaii Housing Finance and Development Corporation, Board of Land and Natural Resources, Land Use Commission, Legacy Land Conservation Commission, Natural Area Reserves System Commission, Board of Directors of the Natural Energy Laboratory of Hawaii Authority, Board of Directors of the Hawaii Public Housing Authority, Public Utilities Commission and Commission on Water Resource Management), will be maintained confidential and neither published nor disclosed by the Ethics Commission without the member’s permission, during the member’s term, and for six years thereafter whereupon they will all be destroyed.

Questions as to whether the members of a particular board must file a disclosure statement, or whether statements filed by the members of a particular board are subject to disclosure should be posed directly to the State Ethics Commission. *
I have read and understand the above statement
Authorization To Release/Disclose Information

To Whom It May Concern:

In conjunction with the background check being conducted by the Office of the Governor for my possible appointment to a state board or commission, I hereby authorize the representative of the Office of the Governor, State of Hawaii, bearing this release, or copy thereof, to obtain information about me that you may have pertaining to my employment, military service, or education, including but not limited to academic, achievement, attendance, personal history, disciplinary actions, awards, and request of the bearer. This authorization to release is executed with my full knowledge and understanding that the information will be used in connection with my application for possible appointment to a state board or commission.

Name *

Type Name in box to sign