Application Form for Request for Non-Practicing Status Posted on August 13, 2012August 20, 2015 by adminED Application for Non-Practicing Status To qualify for Non-Practicing Status, you must not be currently employed or practicing as a VR professional. It is recommended that you maintain E&O coverage as a non-practicing VR professional for your liability purposes. Name First Last Home Address Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Phone Fax Email Employer Information Former Employer Former Employer Address Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Former Employer Contact Employer Contact Email Current Position Start Date Month123456789101112 Day12345678910111213141516171819202122232425262728293031 Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Do you anticipate return to Practice* Yes No Return Date Month123456789101112 Day12345678910111213141516171819202122232425262728293031 Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Reason for Request for Non-Practicing Health Reasons Military Employment Change/interruption Jury Duty Bereavement Maternity/Paternity Return to School Other (describe below) Other Please enter other reason for Sabbatical Requested Current Designation CVRP(I) CVRP(P) CVRP CVRP(F) CVRP(D) CCVE CCVE(F) CCVE(D) CVRP Registration Number Year Certified: Length you have held valid certification (YEARS) Payment Type* Online PayPal $100.00 Paid by WSIB $100.00 Cheque/Money Order made payable to CVRP $115.00 Total $ 0.00 CAD Application Declaration:* By checking here I understand that I must notify the College before I return to ANY active VR employment as I must activate my registration status to Practicing. By checking here I understand that at it is a act of Professional Misconduct to work as a CVRP while registered as Non-practicing status. Application Declaration:* By checking here you agree to all the terms and conditions outline by CVRP in this application I hereby verify that the information submitted for this application accurately documents my request without impinging on my right to Privacy. I understand that providing false information will result in immediate withdrawal of my application and could result in disciplinary action. I understand that it is recommended that I continue to carry current E&O insurance coverage. I hereby declare that the information given in this application is, to the best of my knowledge, true, correct, and complete in every respect and that I am the applicant.
