NOMINATION FORM
FOR CNA PRESIDENT-ELECT
Term: June 2014 to June 2016
1. Nominee
a) Please print or type in all fields below.
SURNAME:
GIVEN NAMES:
PROVINCE(S) OR TERRITORY(IES) OF CURRENT REGISTRATION and REGISTRATION
NUMBER(S):
(Nominee must be a registered nurse member of a CNA jurisdictional member)
FULL MAILING ADDRESS:
TELEPHONE (with area code):
FAX (with area code):
E-MAIL ADDRESS:
CURRENT POSITION:
EMPLOYER:
PREFERRED MAILING ADDRESS:
HOME
WORK
STATEMENT OF PHILOSOPHY demonstrating the nominee’s leadership ability, up to a maximum of
200 words (for inclusion in the Ticket of Nomination to be published in Canadian Nurse and infirmière
canadienne).
ENTER TEXT HERE
CONSENT TO SERVE (please sign):
It is understood that in accepting the nomination for the office of president-elect, the nominee also accepts a commitment to
advance to the office of president.
DATE:
b) If you are nominated by a jurisdictional member or associate member, please e-mail or send* this
completed form and the following attachments to your nominator, who will forward it to CNA with the
documents listed under part 2:
 a recent photograph (colour, in a high-resolution, electronic format)
1
 a curriculum vitae
* Please note that your nominator must send all documents to CNA by November 29, 2013.
c) If you are nominated by an associate member or individual members, you must arrange for a letter or
e-mail notification to be sent by your CNA jurisdictional member (provincial/territorial nurses’ association
and/or college) confirming your current membership. Note: jurisdictional members of CNA are listed on
www.cna-aiic.ca.
d) If you are nominated by individual members, you are responsible for forwarding all documents by the
deadline to CNA.
2. a) Jurisdictional member, if nominator
In addition to the nominee’s information and attachments under part 1, please
 provide a letter of nomination confirming the nominee’s current membership in your
provincial/territorial nurses’ association and/or college, signed by your executive director/CEO and
president; and
 forward all documents by the deadline to the coordinates provided below.
2. b) Associate member, if nominator
In addition to the nominee’s information and attachments under part 1, please
 provide a letter of nomination, signed by your president and executive director/secretary;
 ensure that the nominee has arranged for a letter or e-mail notification to be sent by their CNA
jurisdictional member as outlined in 1(c); and
 forward all documents by the deadline to the coordinates provided below.
2. c) Individual members, if nominators
A minimum of five individual members of CNA must provide letters of support for the nominee.
 Each individual member of CNA must be a member in good standing of a CNA jurisdictional
member.
 The statement of support in each letter should be no more than 200 words.
The nominee is responsible for forwarding all documents by the deadline to the coordinates provided
below.
TO BE RETURNED
NO LATER THAN NOVEMBER 29, 2013 TO:
Governance Coordinator
Canadian Nurses Association
50 Driveway
Ottawa, ON K2P 1E2
Fax: 613-237-5275, e-mail: abaker@cna-aiic.ca
PRIVACY POLICY: Personal information collected on this form will be used only for processing nominations and related follow-up.
2