S-4.2, r. 21 - Regulation respecting the designation procedure for certain members of the board of directors of a public institution

Schedule Disposition versions

2012-09-01

SCHEDULE V

(s. 16)

DESIGNATION

Candidate Information Sheet

PHOTO

Institution(s): ________________________________________________________________________

Candidate’s name: ____________________________________________________________________

Municipality of Municipality of

residence: ____________________ workplace: ____________________

Candidate profile (education, occupation, experience):

Reasons for candidacy:

Social, community, volunteer involvement, etc.:

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. 2006-015, Sch. V.