Please note: All information in this form is collected and will be used and disclosed in accordance with applicable laws.

Step 1: Applicant Information

Demographics
















Mailing Address in Alberta

Mailing Address






Criminal Record Check

Criminal Record Check with Vulnerable Sector Search

Professional Liability Insurance

Professional Liability Insurance

Language

Language


Citizenship

Citizenship


CPR Certification

CPR Certification



Other Registration

Other Registration


Current Employment

Primary Employment






Physical Address








Mailing Address








Additional Employment Information



Education

Education



Additional Education




Declarations

Declarations
Have you ever been convicted of, or been the subject of, a criminal offence or any offence related to the practice of the profession?

Has there ever been a judgement in a civil action against you with respect to your practice?

Are you currently or have you previously been investigated by this College or any other regulatory body within Alberta or in another jurisdiction involving an allegation of unprofessional conduct?

Have you ever been the subject of a finding of unprofessional conduct by this College or any other regulatory body within Alberta or in another jurisdiction?

Has there ever been any conditions imposed upon your practice permit by this College, or any College in Alberta or any other jurisdiction?

I understand that the collection, use and disclosure of my personal information will be handled in accordance with applicable privacy policies and laws.

I understand that I may be required to submit further information to determine eligibility for registration.

Do you give permission for this College to contact any authority or organization in any jurisdiction to verify the above declarations?

I will immediately advise the College, in writing, if there is any change to any of the information contained in this application.

I will immediately advise the College, in writing, should I be convicted of an offense in Alberta or any other jurisdiction.

I will immediately advise the College, in writing, should I become the subject of a finding of or proceeding related to allegations of unprofessional conduct in Alberta or any other jurisdiction.

I will immediately advise the College, in writing, should I be denied registration with any regulatory body in Alberta or any other jurisdiction within the profession of denturism or any other profession.

I will immediately advise the College, in writing, should my practice permit be suspended, cancelled or equivalent with any regulatory body in Alberta or any other jurisdiction within the profession of denturism or any other profession.

I confirm that I will submit my original criminal record check to the College and understand that my application cannot be processed without it.

I verify that all information contained in this application, including these declarations, is complete and accurate. I understand that a false or misleading statement, an omission or misrepresentation may have impact on my registration as a denturist in Alberta.

Method of Payment

Payment Info

$150
$1275
$1425
$71.25
$1496.25


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