Gubernatorial Appointment Application

Gubernatorial Appointment Application

Lieutenant Governor Position
Full Legal Name

First NameLast Name
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth

MonthDayYear
Date
Email
example@example.com
Last 4 Digits of your Social Security Number:
Are you a United States citizen?
Country of Birth:
How long have you been a resident of Arizona?
Occupation
Retired?
Spouse/partner Information

if applicable
Legal Name:

First NameLast Name
Job title:
Employer:
Is your spouse a registered lobbyist?
Questionnaire
Have you ever applied for or held an appointment under any governor?
If yes, please give detailed explanation:
Are you currently a registered lobbyist or have you previously been a registered lobbyist?
If yes, please explain your lobbying work and dates of employment
Is there anything on your social media or public record that would embarrass the Office of the Governor were you to be appointed?
If yes, please give a detailed explanation:
If appointed, do you commit to attending all scheduled meetings and fulfillingall other requirements and duties associated with the position you are seeking?
Have you ever been cited for a breach of ethics for unprofessional conduct, ornamed in a complaint to any court of law or professional group?
If yes, please give a detailed explanation:
Have you ever been convicted, entered a guilty plea, or entered a plea of nolocontendere for any criminal violation other than a moving violation or a similar minor infraction?
If yes, please give a detailed explanation:
Are you currently under charges or indictment for any violation of the law?
If yes, please give a detailed explanation:
Has any individual, group of individuals, or associations formally or informally protested your potential appointment?
If yes, please give detailed explanation:
Are you delinquent on any federal, state, or local debt?
If yes, please include all delinquencies for income, property, other taxes, governmental loans, overpayment of benefits, and required payments into governmental programs:
In the last five years, have you been, or are you presently, involved in any agency proceeding or civil litigation, including proceedings regarding a professional license or certification?
If yes, please give a detailed explanation:
In the last five years, has any business in which you, a spouse, a relative or a business associate been a party to any administrative agency proceeding or civil litigation relevant to the position in which you wish to be appointed to?
If yes, please give a detailed explanation:
Have you ever been a party or involved in any civil or criminal legal proceedings?
If yes, please give a detailed explanation (Please do not include information where no allegations of wrongdoing were alleged against you):
Have you ever been the subject of a complaint of discrimination on the basis of sex, race, religion, national origin, age or disability filed in court or with an administrative agency?
If yes, please give a detailed explanation:
Political Opinions
Explain your position on ICE:
Explain your position on abortion and women's rights:
Explain your position on the border wall:
Explain your position on immigration:
Explain your position on water in Arizona:
Explain your position on state agencies in Arizona needing reformed?
Explain your position on cost of living and affordability in Arizona:
Explain your position on the federal government:
Upload your CV/resume

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References

Please list three professional (not personal) references
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
relationship to reference
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
relationship to reference
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
relationship to reference
Please provide any additional information you would like the Teri Ann Hourihan to be aware of as she considers her appointment.
I hereby certify that the information given above is accurate. I understand that if I give false information I may be disqualified for appointment.
Name

First NameLast Name
Today's date

MonthDayYear
Date
Signature
Should be Empty:

Gubernatorial Appointment Application

Spouse/partner Information

Questionnaire

Political Opinions

References