ELECTORAL (NOMINATION OF CANDIDATES) REGULATIONS, 2013 FORM VN.6 CERTIFICATION OF ELIGIBILITY OF MEMBER OF THE PUBLIC SERVICE FOR NOMINATION AS A CANDIDATE AND FOR ELECTION AS A COUNCILLOR Section 119(5) of Electoral Act [Chapter 2:13] Note. It is provided in section 119(5) of the Electoral Act that a member of the Public Service is eligible for nomination as a candidate for and election as a councillor if the Secretary of the Ministry in which he or she is employed, with the concurrence of the Public Service Commission, has certified in the prescribed form that any of his or her duties as a councillor, should he or she be elected, would not conflict with his or her duties as an employee of the State. Certification of eligibility Surname: ..................................................................................................................................... First names: ................................................................................................................................. Citizenship: ................................................................................................................................. Residential address in full: .......................................................................................................... Postal address in full: .................................................................................................................. Occupation: ................................................................................................................................. Employment code number: ......................................................................................................... Ministry or Government department: ......................................................................................... Department and section numbers: ............................................................................................... Position/Title: ............................................................................................................................. Job description: ........................................................................................................................... Comments of head of department: .............................................................................................. Recommendation of head of department: ................................................................................... Secretary’s recommendations: .................................................................................................... Recommendation of Public Service Commission: ……………………………………………… Signed ……………………………….. Date ……………………………….. (Secretary of the Ministry) Signed ……………………….………… Date ……………………….……… (for Public Service Commission) 72