ICVE Grandfathering Application Form – Canadian Applicants

First Name*

Middle Name

Last Name*

Last

Are you currently a registrant of the CVRP College?*

Yes
No

If yes, please provide all CVRP credentials, registration number and length you have held the credentials.

Are you currently a member of CAVEWAS?*

Yes
No

If yes, please provide all CAVEWAS credentials, registration number and length you have held the credentials.

Are you currently a member of VECAP?*

Yes
No

If yes, please provide all VECAP credentials, registration number and length you have held the credentials.

Are you currently a member of VEWAA?*

Yes
No

If yes, please provide all VEWAA credentials, registration number and length you have held the credentials.

Do you hold a certification through the Commission on Rehabilitation Counselling Certification (CRCC)?*

Yes
No

If yes, please provide CRCC credentials, registration number and length you have held the credentials.

Contact Information

Home Address*

Home City*

Home Province/State*

Home Postal Code/Zip Code*

Personal Email*

Personal Cell Phone

Home Phone*

Employer Information

Current Employer*

Employer Address*

Employer City*

Employer Province/State*

Employer Postal Code/Zip Code*

Work Phone*

Work Cell Phone

Work Email*

Current Position*

Vocational Evaluation Credentials(s)

CCVE
CVE

Length you have held the credentials in years

APPLICATION DECLARATION

I understand that the information provided on this application will be used for purposes of admission, registration, research and development, and other purposes consistent with the mandate of the College of Vocational Rehabilitation Professionals (the College).

I hereby verify that the information submitted for this application is accurate. I understand that providing false or incomplete information could result in action being taken by the College including immediate suspension of my certification of registration. I confirm that it is my obligation to notify the College within 30 days in the event that any of my information changes. I understand that submission of this application in no way guarantees my membership in the College, and that misrepresentation of this information in any way may result in cancellation of my admission or registration status.

I confirm that I have never been convicted of a criminal offense, for which I have not received a pardon that is relevant to my work as a Vocational Rehabilitation Professional and/or a Vocational Evaluator and/or Vocational Forensic Expert.

Application Declaration 1*

By checking the box, I delare the above Application Declaration statement to be true

MISCONDUCT DECLARATION

I confirm that I have not been dismissed from employment or refused membership in a professional association or regulation/registration in a related field, on the grounds of professional misconduct in Canada, the United States of America or anywhere else in practice Internationally.

Misconduct Declaration*

By checking the box, I declare the above Misconduct Declaration statement to be true.

The following questions must be answered. If more space is required, please forward by email to “The Registrar” at registrar@cvrp.ca.

Negligence Complaint*

Regardless of outcome, have you ever been the subject or recipient of a complaint of professional negligence through membership in a professional association or registration in a related field?

Yes
No

Investigation or Inquiry*

Are you now the subject of any type of investigation, inquiry or proceeding by a professional licensing body or professional association relating to your professional conduct, competence, capacity or any other aspect of your professional practice?

Yes
No

Other Complaint*

Are you aware of any facts, circumstances or situations which may reasonably give rise to a complaint other than noted above?

Yes
No

APPLICATION DELCARATION

If accepted as an ICVE through this grandfathering process, I agree to annually review the College Standards of Practice, Code of Ethics and By-Laws. I undertake to abide by all of the rules, regulations, standards and policies of the College of Vocational Rehabilitation Professionals (the Governing Rules and Regulations). I understand that my membership in the College of Vocational Rehabilitation Professionals (the College) is voluntary and that by becoming a member, I consent to the College acting as my professional self-regulating body.

I acknowledge that my membership status in the College of Vocational Rehabilitation Professionals is based on the College’s Governing Rules and Regulations. I agree to abide by the provisions of the Governing Rules and Regulations and I recognize that the College has the right to limit or terminate my membership status under the College’s Bylaws, Policies, Standards of Practice, and Code of Professional Conduct.

As a voluntary member, I hereby release the College of Vocational Rehabilitation Professionals from all liability for any act of negligence or want of ordinary care on the part of the College and or any of its agents. In consideration of my membership in the College of Vocational Rehabilitation Professionals, I waive, release, and discharge the College and their directors, officers, agents and members, their representatives, heirs, executors and assigns from any and all claims of liability. This agreement is binding upon my executors, heirs, and assigns.

I hereby discharge and release from any liability, the College and its authorized representatives, for any acts, communications, or decisions regarding the processing, consideration, and maintenance of my membership application and file. I hereby declare that I have current Professional Liability (Errors & Omissions) insurance coverage for practicing as a Vocational Rehabilitation Professional and/or Vocational Evaluator.

I understand that I must biennially submit proof of approved Continuing Education Units (CEU’s) and must accumulate the total number of CEU’s required to maintain my level of certification. The maintenance level for CEU’s is currently set at 40 per 2-year period, as set-out in the College Continuing Education Policy.
I hereby declare that the information given in this application and any attached / forwarded documents is, to the best of my knowledge, true, correct, and complete in every respect and that I am the applicant.

Application Declaration 2*

By checking the box, I declare the above Application Declaration statement to be true.

CVE Certificate

Vulnerable Sector Police Check

Professional Liability Insurance (Errors & Omissions) Certificate

APPLICATION FEE IN CAD plus applicable taxes*

New ICVE Registrant: Grandfathering Application Fee $225.00

Total

$ 0.00 CAD

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ICVE Grandfathering Application Form – Canada

Contact Information

Employer Information