Application – Canadian RN (TEST) Step 1 of 9 11% Have you ever been registered with the College of Registered Nurses of Newfoundland & Labrador (CRNNL)?(Required) Yes No This is not the correct application. Please contact [email protected]. If you proceed to the application, you will not be able to submit it.Click Next to proceed to the application. In order for your application to be considered complete, you must provide the following: Two government issued ID documents Marriage Certificate or Legal Change of Name document (if applicable) Criminal Record Check (dated within last 6 months) If you do not have these documents, please consider waiting to submit your application. Applicants may also have to submit a Verification of Registration and/or proof of English Language Proficiency. The College will contact you directly if we require these documents. Fee payment ($172.50) will be required in order to process your application. Applications will not be processed until all required documents are received and the fee is paid. Personal InformationIdentification Documents Applicants are required to submit two (2) of the following government issued identification documents: Birth certificate Passport Driver’s license Permanent Resident Card Citizenship Card Immigration Card Please note: Identification documents must be provided to the College in order for your application to be processed. Documents can be uploaded or sent via e-mail or mail. Faxed documents will not be accepted. Documents must be a colour digital image and not a photocopy.Please check one of the boxes below to indicate how you will to send your ID documents.(Required) Upload documents and attach them to this application. Documents will be submitted by e-mail. Documents will be submitted by mail. Upload DocumentsID Document 1Accepted file types: png, jpg, pdf, Max. file size: 6 MB.ID Document 2Accepted file types: png, jpg, pdf, Max. file size: 6 MB.If applicable, applicants must submit a legal change of name document or marriage certificate if they have changed their name. Change of Name DocumentationAccepted file types: png, jpg, pdf, Max. file size: 6 MB. Please provide your name as it appears on your government issued identification:Last (Surname) Name:(Required) First (Given) Name:(Required) Middle Name: Former Name(s): Date of Birth:(Required)Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Month123456789101112Day12345678910111213141516171819202122232425262728293031Please provide your permanent address:Permanent Address:(Required) City:(Required) Province/State:(Required) Country:(Required) Postal Code:(Required) Email:(Required) Enter Email Confirm Email Telephone:(Required) Gender:(Required) Female Male X Language ProficiencyApplicants must meet English Language Proficiency (ELP) through education, registration status, language proficiency testing, or experience. Applicants must review the College’s ELP fact sheet (PDF) to determine if they need to submit a test of ELP or if they meet one of the other methods. Identify the language(s) in which you can competently provide nursing services.(Required) Entry/Initial Nursing EducationIdentify the initial nursing education program you completed to obtain RN registration. University or School of Nursing:(Required) Country:(Required) Type of Program:(Required)DiplomaDegreeMastersGraduation Date:(Required)Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Month123456789101112Day12345678910111213141516171819202122232425262728293031 Other Registration/LicensureList the jurisdiction(s) (province/state/country) where you are currently registered or licensed to practice as a Registered Nurse or Nurse Practitioner. In most instances, the College can verify the applicant’s current registration/licensure online. The College will notify applicants when additional information is required and if a Verification of Registration from another regulatory body will need to be sent directly to the College.Jurisdiction Name Registration # Status (practicing, active, etc) Jurisdiction Name Registration # Status (practicing, active, etc) Jurisdiction Name Registration # Status (practicing, active, etc) If you are registered / licenced in additional provices / states / countries, please provide the information below: EmploymentProvide the following information for your current nursing employer(s). If not currently employed in nursing, provide employment information for your most recent nursing employer. Employer Name: Address:Position Held: Start Date:Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Month123456789101112Day12345678910111213141516171819202122232425262728293031End Date:Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Month123456789101112Day12345678910111213141516171819202122232425262728293031Note: Leave blank if you are still employed with this employer.Were you suspended or terminated from employment with this employer? Yes No You indicated that you have been suspended or terminated. Please provide a brief explanation.Add another employer: Yes No Employer Name: Address:Position Held: Start Date:Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Month123456789101112Day12345678910111213141516171819202122232425262728293031End Date:Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Month123456789101112Day12345678910111213141516171819202122232425262728293031Note: Leave blank if you are still employed with this employer.Were you suspended or terminated from employment with this employer? Yes No You indicated that you have been suspended or terminated. Please provide a brief explanation.Add another employer: Yes No Employer Name: Address:Position Held: Start Date:Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Month123456789101112Day12345678910111213141516171819202122232425262728293031End Date:Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Month123456789101112Day12345678910111213141516171819202122232425262728293031Note: Leave blank if you are still employed with this employer.Were you suspended or terminated from employment with this employer? Yes No You indicated that you have been suspended or terminated. Please provide a brief explanation.Declaration of nursing practice hours: Record your nursing practice hours in the fields below. When calculating your hours ensure: You were licensed as an RN or NP at the time the hours were completed. Do not include vacation, sick time, or other leave of absence hours. Overtime hours must be reported as actual work hours and not paid hours. If you have multiple employers within the year hours should be added together. Enter ‘0’ hours if you have not practiced in a particular year. Enter your annual practice hours below:April 1, 2023 - March 31, 2024 (current year)(Required)April 1, 2022 - March 31, 2023(Required)April 1, 2021 - March 31, 2022(Required)April 1, 2020 - March 31, 2021(Required)April 1, 2019 - March 31, 2020(Required)April 1, 2018- March 31, 2019(Required)HiddenTotal 2 Years:HiddenTotal 5 Years: Criminal Record Check & Good Character DeclarationsCriminal Record Check Applicants must submit a Criminal Record Check (CRC) dated within the last six (6) months. Individuals are encouraged to avail of the following online CRC service provider – CSI Screening and select the Canadian Criminal Record Check (econsent). You must select CRNNL as the recipient for CSI to provide your results electronically to the College within 24-48 hours. If an applicant obtains a CRC though local police or the RCMP the original document will need to be submitted to the College via mail or drop off. For further information visit the CSI website: https://csiscreening.com/ Good Character & Fitness to Practice Declarations The information provided on this application and the answers to the following questions are required in accordance with the Registered Nurse Regulations. If your response to any question is ‘Yes’, you must provide additional information in the comments section and the College will notify you if documentation must be submitted.A: Have you been convicted of an offence under the Criminal Code (Canada), the Controlled Drugs and Substance Act (Canada), Human Rights Act (NL), Personal Health Information Act (PHIA) or a similar penal statue in another jurisdiction (province/territory/country) for which you have not received a pardon?(Required) Yes No Please ExplainB: Are there any outstanding charges against you relating to a criminal offense?(Required) Yes No Please ExplainC: Have you ever been charged with, pleaded guilty to, been convicted of or found to be guilty of an offence, for which you have not received a pardon, including alcohol or drug related offenses but excluding parking, speeding or similar minor motor vehicle offenses that do not involve substance use?(Required) Yes No Please ExplainD: Have you ever pleaded no contest or made any similar plea to any criminal charge?(Required) Yes No Please ExplainE: Have you ever been charged with or accused of a criminal offence that resulted in you entering into a diversion program, conditional discharge or other resolution process as an alternative to conviction or prosecution?(Required) Yes No Please ExplainF: Has there ever been any civil proceeding, legal action, insurance or other claim that was in any way related to your practice of nursing?(Required) Yes No Please ExplainG: Have you ever agreed to a settlement as a means to resolve civil proceedings or in relation to any investigation, proceeding or disciplinary action with respect to your professional conduct, competence, character, capacity or fitness to practice?(Required) Yes No Please ExplainH: Have you been denied registration in another jurisdiction (province/territory/country) within the last five (5) years?(Required) Yes No Please ExplainI: Are there currently any conditions or restrictions on your registration or licence?(Required) Yes No Please ExplainJ: Is your registration/license to practice nursing under review/investigation, suspended or revoked; or are there any disciplinary procedures commenced, in process or pending, in another jurisdiction (province, territory or country)?(Required) Yes No Please ExplainK: Have you ever been disciplined by a nursing registration/licensing authority?(Required) Yes No Please ExplainL: Have you ever, before or during the course of an investigation or disciplinary proceeding, voluntarily entered into an undertaking or otherwise agreed to restrict your practice or to refrain from practice?(Required) Yes No Please ExplainM: Have you ever been suspended or terminated from any nursing employment?(Required) Yes No Please ExplainN: Is there to your knowledge or belief, any event, circumstance or condition concerning your competence, character, capacity, conduct or reputation that may impact your ability to practice safely?(Required) Yes No Please ExplainO: Do you have any physical or mental conditions or disorders that may or does currently impair your ability to practice nursing safely and competently?(Required) Yes No Please Explain DeclarationsApplicants must check each box below. I declare that I have read and agree with each of the following declaration statements:Consent(Required) I consent for CRNNL to obtain confirmation or verification of the documentation and information submitted as part of this application.(Required)Consent(Required) I declare that the information provided in this application is true and correct.(Required)Consent(Required) I attest that I am the person completing this application.(Required)Consent(Required) I understand that the college will immediately stop the assessment of my application while they gather more information if:(Required)a. I have provided any inaccurate information; orb. I have omitted required information; or c. The College determines that any documents submitted during the application process have been altered tampered with or forged.Consent(Required) I understand that any and all information provided by me to the College in the course of the application process may be used internally by the College for any of its regulatory functions.(Required)Consent(Required) I confirm that I have disclosed in this application all events, circumstances, or conditions concerning my capacity, competence, character, conduct or reputation that may impact my ability to safely and ethically practice nursing.(Required) Fee PaymentThe College will manually process your payment. Please enter your credit card information below. The College does not retain credit card information. Application fee: $172.50 Method of payment:(Required) MasterCard/MasterCard Debit VISA/VISA Debit American Express Discover Diners Club International Credit Card Number:(Required) Expiry Date:(Required) Security Code (3 digits on back of card):(Required) Is the billing address associated with this credit card the same as your permanent address (above)?(Required) Yes No Please provide the billing address:Address:(Required) City:(Required) Province/State:(Required) Postal Code:(Required) Country:(Required) Date:(Required) EmailThis field is for validation purposes and should be left unchanged. Member Search