Progressive Conservative Party of Newfoundland and Labrador PO Box 8551 w St. Johns, NL w A1B 3P2

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1 CANDIDATE NOMINATION FORM Name: Electoral District Seeking Nomination: Phone: The disclosure provided herein is for the exclusive use of the and may be used to inform the assessment of your potential eligibility as a candidate for the. I have reviewed Article 3 of the Constitution of the and I support the purpose, aims and objectives of the Party. YES NO I am a Member of the PC Party of NL YES NO I have read and understand Article 12 (Selection YES NO of Party Candidates) of the Constitution of the Progressive Conservative Party of Newfoundland and Labrador I will abide by all Elections NL rules and policies YES NO with respect to running in an election should I become the successful candidate I agree to pay a non- refundable $ nomination YES NO fee to the PC Party of NL Signature of Nominee Witness Date Date 1

2 Full Legal Name CANDIDATE DISCLOSURE AND VETTING INFORMATION (attach additional pages if necessary) Surname at birth (if different from above) Date of birth Place of birth Marital Status Spouse s Name (if applicable) Status of Canadian citizenship: Canadian citizen by birth Became Canadian citizen on: (specify date) Have you ever been a citizen of any country other than Canada? First Language Other Languages, if applicable Residential Address 2

3 Mailing Address (if different than Residential Address) Mobile Telephone # Home Telephone # Please indicate your educational history since secondary school, including names of institutions attended, and periods of attendance, and graduation date(s), if applicable. Please indicate any professional designations that you hold and any professional associations of which you are currently a member. Please indicate your employment history for the past 10 years. (Please account for the entire 10 years, including any periods wherein you were not gainfully employed, if applicable). Please advise of any social, recreational, political, cultural, community or other organization of which you are/have been a member within the past 5 years? 3

4 Please advise of any provincial, territorial or federal political party of which you have been a member, the positions you held or sought (if any) and the period during which you held said position(s), if applicable. Have you ever engaged in, or been associated with, activities that promote discrimination or hatred against people, whether on the basis of race, national or ethnic origin, colour, religion, age, sex, sexual orientation, or disability? Are you, and/or any proprietorship/partnership/corporation for which you are a directing mind, a party to any ongoing litigation? If so, please identify all parties to said litigation and the jurisdiction in which the litigation has been commenced. To the best of your knowledge, are there any present circumstances that may give rise to a cause of action as against you and/or any proprietorship/partnership/corporation for which you are a directing mind? Have you, or any proprietorship/partnership/corporation for which you are a directing mind, ever received any financial assistance from any municipal, provincial or federal government or agency thereof? 4

5 Have you, or any proprietorship/partnership/corporation for which you are a directing mind, filed for bankruptcy? If so, please advise whether a discharge has been issued in relation to said bankruptcy, and the date of the issuance of said discharge. Have you ever been dismissed from employment for cause? Have you ever been disciplined by a self- regulating professional body? Are you aware of any ongoing investigation by any self- regulating professional body in relation to the discharge of any of your professional responsibilities? Have you ever been charged with a criminal offence? Do you have any outstanding liabilities to any Canadian taxation authorities? If yes, please specify what, if any, payment arrangements you have made in relation to same. 5

6 Have you been subject to any form of academic discipline for alleged dishonesty or plagiarism infractions? Is there any online imagery, including, but not limited to, videos, photographs, social media posts, or other online commentary of, by, or in relation to you, which may impact your potential suitability as a candidate for the Progressive Conservative Party of NL? Have you ever authored a blog? If any such blog is currently available online, please specify particulars. Do you, or have you ever had, a website wherein you have authored content in your own right? If any such website is currently available online, please specify particulars. Have you had a presence on any social networking sites, including, but not limited to, Facebook, Twitter, or Instagram in the past five years? If so, please advise of sites on which you are/have been active in the past five years. Have you ever been found guilty of an offence pursuant to the Labour Standards Act, RSNL 1990, c L- 2, and/or the regulations enacted thereunder? 6

7 CANDIDATE NOMINATION INFORMATION To Become an Official Candidate of the PC Party of NL a person must: 1) Be a Member of the PC Party of NL by signing up on the website ( 2) Be at least 18 years of age 3) Submit the above form to the Secretary of the Party 4) Pay a non- refundable $ nomination fee to the PC Party of NL in the form of Cash, Cheque or Money Order made payable to the district association where the nominee is seeking the nomination before the close of nominations. This can be submitted directly to the President of the District Association, or in the circumstance where a district association is not prepared to accept the cheque, to the Treasurer of the PC Party of NL. In the event of two or more candidates at the close of nominations the Party, in consultation with the District Association, will call a nomination meeting in order to determine the candidate. Eligible voters at a Nomination meeting are those who are members of supporters of the district association and who are ordinarily residents of the district in question. Voters must be 16 years of age or greater. PC Party of NL Contact Information: Charlotte Halleran President Challeran2015@gmail.com Eugene Manning Vice President manning.eugene@gmail.com Rhonda McMeekin Secretary secretary@pcnl.ca Chris Wakeham Treasurer cwakeham.nl@gmail.com

8 AFFIDAVIT I, of the city/town of in the province of, make an oath as follows: 1. THAT, I hereby confirm that I am seeking the nomination as the Progressive Conservative Candidate in the provincial electoral district of, and as such have full knowledge of the matters herein disposed to. 2. THAT I have personal knowledge of the matters required to be verified in the annexed Candidate Nomination and Candidate Disclosure and Vetting Form and that the statements contained therein are true. Nominee Signature Witness Signature 8