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Maricopa County Workforce Development Board Membership Application
Page 1 of 4
Revised 01/24/2020
Maricopa County
Workforce Development Board (WDB)
Nomination Application
Name:
Position/Title:
Business/Organization Representing:
Representation
Please complete the section relevant to the category that you represent:
Category 1: Business Representative
A. Select one of the following Roles that you fulfill:
Business Owner
Business Chief Executive Officer or Chief Operating Officer
Other (Describe policy-making and/or hiring authority) ________________________________________
________________________________________________________________________________________
B. Select one of the following Business Types that you represent:
Private Sector Large/For-Profit Business (500 employees or more)
Private Sector Small/For-Profit Business (fewer than 500 employees)
Organization Representing Business
C. Describe the In-Demand Industry or Occupation represented by your business:
D. Describe Employment Opportunities in the In-Demand Industry or Occupation provided by your
business:
E. Describe the nature of your business and your position. Please include a description of your policy-
making and hiring responsibilities within your organization, including the role you play in training and/or
employee development:
F. Select Organization Type nominating you:
Local Business Organization (List Org Name)________________________________________________
Business Trade Association* (List Org Name)________________________________________________
*Association type must be affiliated with the in-demand industry represented by your business.
Christopher Tafoya
Deputy Administrator
State of Arizona, Department of Economic Security, WIOA Title III
Maricopa County Workforce Development Board Membership Application
Page 2 of 4
Revised 01/24/2020
Category 2: Workforce Representative
A. Select one or more of the following Organization Types that you represent:
Labor Organization
Registered Apprenticeship Program (Joint Labor-Management or Union-Affiliated)
Community-Based Organization (CBO) providing services to individuals with barriers to employment
Youth Training, Employment, or Education Organization (WIOA-eligible Youth)
B. If you selected Registered Apprenticeship Program above, select one of the following Roles that you
fulfill:
Training Director
Member of a Labor Organization (List Org Name)_____________________________________________
C. If you selected Community-Based Organization above, describe the organization’s Demonstrated
Experience addressing employment, training, and education needs to those with barriers to employment.
D. If you selected Youth Training, Employment, or Education Organization for Disconnected, describe the
organization’s Demonstrated Experience addressing employment, training, and education needs to WIOA-
eligible youth. Please state if the experience is serving in-school or out-of-school youth.
E. If you selected Labor Organization or Registered Apprenticeship Program above, list the Local Labor
Federation nominating you:________________________________________________________________
Category 3: Other Representative
A. Select one of the following Organization Types in which you have optimum policy-making authority:
Adult Education and Literacy Provider (WIOA Title II)
Higher Education (Providing workforce development activities)
Economic and Community Development Entity
Wagner-Peyser (Arizona Department of Economic Security)
Vocational Rehabilitation (Arizona Department of Economic Security)
B.
Name of Organization nominating you:______________________________________________________
Additional Information
Business/Organization Address:
City:
State:
Zipcode:
Phone:
Fax:
Mobile:
Email address:
Website address:
Business license number:
Department of Economic Security Statewide WIOA Title III
1789 W Jefferson St
Phoenix
AZ
85007
602-542-2606
520-330-0446
CTafoya@azdes.gov
www.arizonaatwork.com
Maricopa County Workforce Development Board Membership Application
Page 3 of 4
Revised 01/24/2020
1. The Maricopa County Board of Supervisors values member diversity in geographic location, gender, and
ethnicity. Briefly describe how your appointment would contribute to the diversity of the Workforce
Development Board. (Response Optional)
2. Please list your current chamber and association memberships, the duration of each membership and the
positions you currently hold:
3. Please list any professional award(s) or recognition you have received within the last 5 years:
Maricopa County WDB Related Questions
Please answer the following questions and attach any additional pages, if necessary:
1. The purpose of the WDB is to provide strategic leadership and operational oversight to Maricopa County’s
workforce development system through building partnerships, developing career pathways, and providing high-
quality workforce development services. What knowledge skills, and abilities do you have that would assist the
WDB in effectively achieving this?”
2. Membership on the Maricopa County WDB requires that each member attend a full WDB meeting every month,
attend training sessions for board members and become an advocate for workforce development. The time
commitment for these activities ranges from 4 to 10 hours per month. Can you make this time commitment?
Yes
No
3. Serving on a subcommittee of the Maricopa County WDB is strongly encouraged. The time commitment for this
activity ranges from 3 to 4 hours per month. Can you make this time commitment? Yes
No
4. Why do you wish to serve on the Maricopa County WDB? (Describe in 100 words or less)
Local Veterans Employment Representative of the Year 2016 American Legion.
In current role as Title III Wagner-Peyser deputy administrator have served on Pima County
and Yavapai Workforce Development Board. 3 year of board experience in building
partnerships and strategic leadership to enhance local workforce development areas.
Support the continued growth and development of Maricopa Workforce Development Board.
To utilize my experience to further the strategic vision. Enhancing key partnership and
provide high-quality workforce development services to the board and as a title III partner.
Maricopa County Workforce Development Board Membership Application
Page 4 of 4
Revised 01/24/2020
References
Please list professional references below.
Professional Reference:
Name:
Title:
Company:
Phone:
Professional Reference:
Name:
Title:
Company:
Phone:
Professional Reference:
Name:
Title:
Company:
Phone:
Additional Required Documentation
Nomination Letter: Please include a letter from a senior executive of the nominating organization you
listed above in your category of representation.
Current Resume
Signature and Acknowledgement
I, the undersigned, certify that the information on this application is true and correct to the best of my knowledge
and that, if appointed to serve, I will do so to the best of my ability and in the best interest of Maricopa County
and its citizens.
Signature:
Date:
Please submit applications to the BoardsAndCommissions@maricopa.gov.
For more information about the Maricopa County Workforce Development Boards visit: www.maricopa.gov/378
To be completed by County official only
Date received by Maricopa County:
Received by:
Chevera Trillo
Adminstrator
Department of Economic Security
602-542-0929
Marla Lazere
Administrator
Department of Economic Security
623-512-0583
Lynn Larson
Deputy Assistant Director
Department of Economic Security
602-542-2261
Tafoya, Christopher
Digitally signed by Tafoya,
Christopher
Date: 2020.03.13 09:02:56 -07'00'
3/13/20