C-26, r. 7.1 - Regulation respecting the recruitment and selection procedure for disciplinary council chairs of professional orders

Schedule Disposition versions

2014-03-06

SCHEDULE A

(ss. 3 and 4)

REGISTRATION FORM UNDER THE REGULATION RESPECTING THE RECRUITMENT AND SELECTION PROCEDURE FOR DISCIPLINARY COUNCIL CHAIRS OF PROFESSIONAL ORDERS

RECRUITMENT OF PERSONS QUALIFIED TO BE APPOINTED DISCIPLINARY COUNCIL CHAIRS OF PROFESSIONAL ORDERS

SCHEDULE A
(ss. 3 and 4)
REGISTRATION FORM UNDER THE REGULATION RESPECTING THE RECRUITMENT
AND SELECTION PROCEDURE FOR DISCIPLINARY COUNCIL CHAIRS OF
PROFESSIONAL ORDERS
RECRUITMENT OF PERSONS QUALIFIED TO BE APPOINTED DISCIPLINARY
COUNCIL CHAIRS OF PROFESSIONAL ORDERS
CANDIDACY FILE
NOTICE: The documents and information relating to your candidacy are treated in a confidential manner.
1 Identity
Surname Given name
2 Contact information and various information (please complete Schedule I)
3 Nature of activities engaged in that enabled you to acquire the required relevant experience (please complete
Schedule II)
4 Consultations provided for in section 4 of the Regulation
Please designate any person who, during the last ten (10) years, was your employer, partner, immediate
superior or hierarchical superior
Name
Title or
position held
Organization Address Telephone
Please identify any legal person, partnership or professional association of which you are or were a member
during the last ten (10) years
Name Address Telephone
5 Declaration under section 4 of the Regulation (please complete Schedule III)
6 Summary of the reasons for your interest in holding the position of disciplinary council chair of
professional orders (please complete Schedule IV)
7 Certification and consent
I certify that the information provided is complete and in keeping with the truth. I understand that a false statement may entail
rejection of my candidacy.
I authorize the selection committee or the persons mandated for that purpose to carry out the verifications deemed necessary.
(Signature) (Date)
Send the form, duly signed, to the address indicated in the notice of recruitment.

O.C. 76-2014, Sch. A.