O-7.2, r. 1 - Regulation respecting the procedure for designating certain members of the board of directors of integrated health and social services centres and unamalgamated institutions

Schedule Disposition versions

2015-04-08

SCHEDULE II

(Section 9)

DESIGNATION

Candidate Information Sheet

PHOTO

Institution(s):

_____________________________

Candidate’s name:

_____________________________

Place of work or of practice of a profession:

_______________________________________

Candidate profile (education, occupation, experience):

Reasons for candidacy:

Social, community, volunteer involvement, etc.:

Other relevant information:

Candidate’s consent: I authorize the disclosure of the information herein as part of the designation process in which I am a candidate.

__________ ____________________

Date Candidate’s signature

__________ ____________________

Date Designation officer’s signature

M.O. 2015-005, Sch. II.