Application for gubernatorial appointment to a board or commission

** Please note that pursuant to the state's Public Records Act (RCW 42.56), applications submitted for these appointments are subject to public disclosure. If you have any questions, call (360) 902-4111.**

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I hereby authorize that my criminal record history and tax records be released to the Governor or the Governor's representative and certify that the information provided in this application is true, correct, and complete to the best of my knowledge.