Candidate
Questionnaire
Step
1
of
5
20%
Do you believe that Texas would be better off as an independent nation?
(Required)
Yes
No
Do you currently live in Texas and have you lived in Texas for the last two years?
(Required)
Yes
No
If you have previously or currently hold office, which office did you hold?
(Required)
For which public offices would you consider running?
(Required)
(Check all that apply)
State Senator
State Representative
State Board of Education
County Judge
County Commissioner
Mayor
City Council
School Board
Other (please specify)
Other (Public Offices consider running)
What specific office are you seeking?
Ex: County Commissioner, Precinct 4, Jefferson County or State Rep. District 31.
What label do you intend to run under?
(Required)
Democrat
Republican
Libertarian
Green
Independent
How will you integrate the concept of Texas independence into your campaign?
(Required)
Please be specific, as to how you will meld this into your literature, stump speech, etc.
Is there anything in your personal life that would prevent you from mounting a serious campaign, such as an illness in the family?
(Required)
Yes
No
Please list them here
(Required)
How much time will you be able to devote to your campaign?
(Required)
Why do you want to run for office under the TNM banner?
(Required)
What other issues will be focal points of your campaign?
(Required)
Confirmation
(Required)
I confirm my commitment to be considered as a candidate for the Take Texas Back Campaign in the next general election: *
To take your application further, we need you to fill out this application in full and to consent to a number of background checks (including not by way of limitation) criminal, social media and credit checks.
(Required)
By checking this box, I consent to a comprehensive background check
Please confirm that you have read the Texas Secretary of State eligibility guidelines (accessed through this link
https://www.sos.texas.gov/elections/candidates/guide/2020/qualifications2020.shtml
) and confirm that there are no criteria which would disqualify you as a candidate.
Confirmation
(Required)
I confirm I have read the guidelines and can see no reason why I can’t stand as a candidate
If I am selected to be a Take Texas Back Campaign supported candidate for office, I am prepared to devote time to work with the Campaign to begin establishing a presence in the district and setting up a campaign structure immediately
(Required)
Yes
No
I am not aware of any past or current issues in my background that may embarrass the Texas Nationalist Movement or Take Texas Back Campaign or bring them into disrepute, and commit to notify the TTB promptly of any such issues that may occur in the future in the period while being considered to be a candidate or once selected as a candidate
(Required)
Yes
No
Please supply us with your contact information:
First name
(Required)
Last name
(Required)
Phone number
(Required)
Email address
(Required)
Date of Birth
(Required)
MM slash DD slash YYYY
Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Please upload a copy of your Resume [CV] (PDF or Word document)
(Required)
Accepted file types: pdf, doc, docx, Max. file size: 1,000 MB.
Please upload a copy of the photo page of your passport or State issued ID. This can be a scan or a photograph. This will be used to verify your identity and will be processed in accordance with the Texas Nationalist Movement's
Privacy Policy
.
Upload a copy of photo page of your passport or State issued ID
(Required)
Accepted file types: jpg, jpeg, png, pdf, gif, Max. file size: 1,000 MB.
Please upload a copy of a recent utility bill showing the address of your main residence
(Required)
Accepted file types: jpg, jpeg, png, pdf, gif, Max. file size: 1,000 MB.
The Take Texas Back Campaign is a broad movement, reflecting all political perspectives. To optimize the Campaign’s competitiveness against different oppositions in different constituencies, how would you describe your political leanings:
(Required)
Left
Center
Right
Other
Other (Political Learnings)
Which if any of the following parties have you joined, been active in:
(Required)
Democratic Party
Green Party
Libertarian Party
Republican Party
Other
Other (Political Party)
Have you ever stood for election before?
(Required)
Yes
No
In a series of bullet points, tell us why you should be considered as a candidate that the Texas Nationalist Movement should support:
(Required)
In a series of bullet points, tell us the political messages you would like to deliver:
(Required)
Please provide the URLs to any of the following accounts you have:
Personal website
Facebook
Twitter
LinkedIn
Instagram
Have you ever used any dating/hookup websites or apps?
(Required)
Yes
No
Please list them here (with User Name(s))
(Required)
By submitting this application, I declare that: I have answered all the questions truthfully to the best of my knowledge I have uploaded:
A current passport photo page, or Driver’s License
A current CV (resume)
A recent utility bill
I am qualified to stand and to be elected I have read the Texas Secretary of State guidelines relating to circumstances in which I may be disqualified from standing as a candidate and believe that there is nothing in the guidelines which would prevent me from standing as a candidate. *
Confirmation
(Required)
I have read the Texas Secretary of State guidelines relating to circumstances in which I may be disqualified from standing as a candidate and believe that there is nothing in the guidelines which would prevent me from standing as a candidate
Confirmation
(Required)
I consent to the Take Texas Back Campaign processing this application in accordance with their privacy policy. I consent to the TNM contacting me via email or phone to discuss my application
Confirmation
(Required)
I understand that should I be selected as a Take Texas Back Campaign backed candidate and the press pick up on any matter that I have not disclosed which the Take Texas Back Campaign considers to be a serious omission and which is likely to bring the Campaign into disrepute, the Campaign reserves the right to release all or part of this application to the press