Information provided on this from will be a public record subject to free and open examination by any
person under the Arkansas Freedom of Information Act.
Applicant Information:
Name: Telephone Number:
Physical Address: Alternate Number:
State: E-mail Address:
Zip Code: Length of Residency in Little Rock:
Are you registered to vote in the City of Little Rock? Yes No
Please explain your interest in serving the City of Little Rock:
Are you aware of what the role of a Civil Service Commissioner is? Please state why you want to be a Civil Service
Have you written or interpreted employment policies and/or procedures for a workforce? If so, in what capacity have you done
so and for how long?:
Can you consistently attend regularly scheduled Civil Service Commission Meetings (twice per month) which may occasionally
last in excess of one (1)-day during hearings? Will you be able to attend additional meetings, which may be convened?:
Describe a situation(s) which led you to take disciplinary actions:
Describe and appeal hearing to a disciplinary action in which you actively participated:
During disciplinary appeal hearings, would you be able to base your decision entirely upon the facts without preference to
management or the employee?:
Please upload a current resume with your application. Submit forms to: Little Rock City Clerk's Office, 500 West
Markham Street, Room #200, Little Rock, AR 72201; by e-mail to or by fax to
(501) 371-4857.
Board and Commission meetings may require day or evening attendance. For more information regarding
boards and commissions, including meeting times and duties, please visit
Self-Identification Survey
The City of Little Rock and the Racial and Cultural Diversity Commission seeks to increase diversity in
applicants for City Boards and Commissions. Your demographic information will be used to track and
enhance diversity in our Boards or Commissions.
Race/Ethnic Group:
Black or African American
Hispanic or Latino (of any race)
American Indian or Alaskan Native
Native Hawaiian or Other Pacific
Male Female
18-25 26-35 36-45 46-55 56+
How did you learn of this Board/Commission vacancy?
City Website Newspaper
Community Agency Referred by Board/Commission Member
Local Government Access Channel Referred by City Director or Staff
The City Code of Ethics prohibits any the member of any City Board, Commission or Authority, form voting
on a matter in which the member has an interest, or the member's family or business has an interest. If
such a matter comes before the body to which you are appointed, and there is any question about recusal,
you should contact the City Attorney's Office for an informal or formal opinion as to the propriety of your