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City of Clarksville

james.halford@cityofclarksville.com

One Public Square Clarksville, Tn 37040

(931) 645-7444

Application for Board or Commission Appointment

City of Clarksville employees and those who contract with the City are not eligible to serve on boards and commissions.

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    Have you ever been convicted of a crime or felony?

    Have you ever had a professional/occupational license revolked, or suspended as a result of disciplinary action?

    Do you currently have any contractual or other arrangement with the city or any of its agencies which would result in a direct or indirect benefit to you?

    Do you intend to enter into any contractual or other arrangement with the city or any of its agencies which would result in a direct or indirect benefit to you in the future?

    Diversity Information: The Mayor of Clarksville desires broad representation on boards, representative of the entire City of Clarksville. 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?) Check all that apply.

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