S-4.2, r. 12 - Regulation respecting the election by the public of certain members of the board of directors of the public institution referred to in Part IV.2 of the Act respecting health services and social services

Schedule Disposition versions

2012-09-01

SCHEDULE II

(s. 11)

PUBLIC ELECTION

NORD-DU-QUÉBEC INSTITUTION

Candidate Information Sheet

PHOTO

Institution: __________________________________________________________________________

Subregion number: __________

Candidate’s name: ______________________________

Municipality or city of Municipality or city of

residence: ____________________ work: ____________________

Candidate profile (training, profession, experience):

Reasons for running:

Social, community, volunteer involvement, etc.:

Candidate’s consent: I hereby authorize the disclosure of the information on this sheet as part of this election.

__________(Date)__________ __________(Candidate’s signature)__________

__________(Date)__________ __________(Returning officer’s signature)__________

M.O. 2006-014, Sch. II.