Get Tennessee Application For Gubernatorial Appointment To A Board Or Commission

APPLICATION FOR GUBERNATORIAL APPOINTMENT TO A BOARD OR COMMISSION Board or Commission for which you would like to be considered Please Print or Type Name Address and Business Information Name First Middle Last Title Home Address Ms. Dr. Business Address Zip Code Home Phone Home Fax Mobile Phone E-mail House District Mr. Business Phone Business Fax Current Employer Position Senate District Personal Information Gender Female Male Date of Birth Social Security No Education and General Qualifications Level Name of School Location City State Did you Graduate Type Degree s Year Graduation/ Degree Awarded Major Course of Study High School/GED College/Other Graduate/Postgrad. Licenses held if applicable Special Skills and Qualifications Community Activities/Organizational Affiliations current Declarations Are you registered to vote in Tennessee Yes No Have you ever been convicted of a crime or felony If yes provide written details. APPLICATION FOR GUBERNATORIAL APPOINTMENT TO A BOARD OR COMMISSION Board or Commission for which you would like to be considered Please Print or Type Name Address and Business Information Name First Middle Last Title Home Address Ms. Dr. Business Address Zip Code Home Phone Home Fax Mobile Phone E-mail House District Mr. Business Phone Business Fax Current Employer Position Senate District Personal Information Gender Female Male Date of Birth Social Security No Education and General Qualifications Level Name of School Location City State Did you Graduate Type Degree s Year Graduation/ Degree Awarded Major Course of Study High School/GED College/Other Graduate/Postgrad* Licenses held if applicable Special Skills and Qualifications Community Activities/Organizational Affiliations current Declarations Are you registered to vote in Tennessee Yes No Have you ever been convicted of a crime or felony If yes provide written details. Have you ever had a professional/occupational license revoked or suspended as a result of disciplinary action Are you a current employee of the State of Tennessee If yes please specify the groups you represent. Are you a citizen of the U*S* Are you a Permanent Resident of the U*S* Is there anything in your background that might become an embarrassment to you if it were to become public No If yes please list the board or commission* Diversity Information* The Governor desires broad representation on boards representative of the entire State. The information below will assist in this goal and is voluntary on your part. Ethnicity Of what race or ethnicity do you consider yourself to be Black/African-American White/Caucasian Native American Latino/Hispanic Asian or Pacific Islander Other please specify Senior/Elder Citizen 60 yrs or older Person with Disabilities Veteran of U*S* Armed Forces Young Adult 16-24 yrs Gay Lesbian Bi-Sexual Transgendered GLBT Note You should also attach a current resume or biographical sketch to this application form I certify that the facts and declarations contained in this application are true and correct to the best of my knowledge.