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Governor's Office

101 N Carson St, Carson City, NV 89701 Nevada State Capitol Building

Form Section 1

Disclaimer: Personal Identification Information (PII) collected from this form will only be used by the Governor’s office to contact the requestor, and technical support of the environment. We will not disclose any of your PII collected from this form and will ensure we follow NRS 603 on PII.

Completion of this application and a successful background check is a requirement for your appointment by the Governor to a Board, Commission, Committee, Authority, or other Position of Trust. Information submitted on this form may be subjected to public disclosure under NRS Chapter 239, Public Records.

Note:  All fields are required fields.  If a field doesn't apply to you please enter N/A.

Biographical Information


Professional Information


Identify all of your professional license(s) below. Email a copy of each document to

Educational History

Specify school attended, year of graduation and type of degree received

Background Information

If you answer "yes" to any question below, please mail explanations with the documents to be downloaded, printed and mailed in the section below.