S-4.2, r. 22 - Regulation respecting the procedure for designating 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

Full text
(s. 13)
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. 2006-013, Sch. V.