COLLEGE OF VETERINARIANS OF BC (CVBC) Application for Registration

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1 Applicatin fr Registratin The prcess f registratin with the CVBC is gverned by the Bylaws, Part 2 Registratin. Under s. 2.3 (1), General rules and criteria, an applicant seeking registratin in a class f active registratin r the nnpracticing class f registratin must prvide a cmpleted applicatin frm tgether with: an riginal f a required dcument, r a cpy certified by a cmmissiner f aths r ntary public in Canada; a certified English translatin, if required; payment fr the applicatin; and payment fr the bylaw exam and seminar, r a request fr a waiver r exemptin, if applicable. All supprting dcumentatin must nt predate the applicatin by mre than ne mnth r the registrar will refer the applicatin t the registratin cmmittee fr directin (bylaw s.2.3 (2)). All payments as set ut in Schedule C t the Bylaws must be prvided in Canadian funds. Registratin Dcument Review All requirements, including a passing mark n the CVBC bylaw exam, must be cmpleted befre an applicatin fr registratin will be cnsidered by the registrar. An applicant may expect t be registered within tw weeks f submitting all required dcumentatin and passing the bylaw exam, if all requirements are met. It is the respnsibility f the applicant t allw sufficient time fr submissin and review f all required registratin dcumentatin prir t an anticipated start date fr emplyment. Registratin n a specific date cannt be guaranteed, particularly during perids f ffice clsure. The CVBC has the bligatin t investigate any cncerns that might arise regarding an applicant fr registratin. The registrar may refuse t grant registratin, in which case the applicatin file will be referred t the registratin cmmittee. The registratin cmmittee may direct the registrar: t register an applicant with full, prvisinal r limited registratin as defined in the bylaws, s. 2.7, s. 2.8, and s. 2.10, respectively; t btain further r additinal infrmatin r clarificatin; r t hld a registratin hearing. Where t submit yur Applicatin fr Registratin Frm, fees and supprting dcumentatin Please send the riginally signed Applicatin fr Registratin Frm and all additinal sheets and supprting dcumentatin with a cheque r mney rder in Canadian funds t: Registratin Assistant, CVBC, Airprt Executive Park Building 7, # Shellbridge Way, Richmnd, BC V6X 3C6 Canada. Fr assistance please cntact the registratin assistant at r by at Revised t 27 September

2 Applicatin fr Registratin T the Registrar f the Cllege f Veterinarians f British Clumbia: I, First Name Middle Name Last Name Full name, printed legibly (please nte that this will be the name under which yu will be registered in the register and the Online registry) f: Address City Prvince/State Cuntry Pstal Cde Telephne Number E mail Address Yu must prvide cmplete and current cntact infrmatin t the CVBC and keep this infrmatin up t date with the CVBC at all times. hereby make applicatin fr registratin fr the fllwing class f registratin (Please mark One nly): Private Practice Temprary Fr External Licensed Veterinarian Public Sectr Specialty Private Practice Nn practicing I declare that: 1. My immigratin status in Canada is (Please mark One nly): Canadian Citizenship status permanent resident f Canada Canadian wrk permit Please prvide a cpy as declared by a cmmissiner f aths r ntary public in Canada. Revised t 27 September

3 Applicatin fr Registratin 2. I graduated (r I am abut t graduate) with a degree r diplma in veterinary medicine frm: Veterinary schl Year Degree (eg., DVM, BVSc, ther) Required: cpy f yur veterinary degree r diplma certified by a cmmissiner f aths r ntary public in Canada. New r imminent graduates f accredited veterinary schls wh have passed the Nrth American Veterinary Licensing Exam (NAVLE) and d nt have a Certificate f Qualificatin (CQ) frm the Natinal Examining Bard (NEB) f the Canadian Veterinary Medical Assciatin (CVMA) must direct: (1) the NEB t send the scres directly t the CVBC, and (2) the Dean f the veterinary schl t send cnfirmatin f cnvcatin directly t the CVBC, r prvide true cpies certified by a cmmissiner f aths r ntary public in Canada. Fllwing graduatin, the CVBC requires a cpy f the veterinary degree r diplma certified by a cmmissiner f aths r ntary public in Canada. 3. Registratin in the Temprary Fr External Licensed Veterinarian (TEMP) class f registratin t prvide a lcum service, requires a signed undertaking (see attachment at the end f the applicatin). Attendance at the bylaw seminar and passing the bylaw exam is nt required. 4. Registratin in the Specialty Private Practice (SPP) class f registratin des nt require a CQ. T be recgnized as a Diplmate (ie., a specialist ) yu must prvide: a) Prf by means f a certified cpy f the diplma and a Letter f Gd Standing that yu hld a current diplmate status in a recgnized veterinary specialty as administered by the ABVS (Advisry Bard n Veterinary Specialties); and b) A signed undertaking agreeing t restrict yur practice as a veterinarian t the scpe f the diplmate certificate held (see attachment at the end f the applicatin fr the frm f undertaking). 5. Registratin in the Public Sectr (PS) class f registratin des nt require a CQ. Yu must prvide: a) Prf f emplyment as a veterinarian in British Clumbia by the Crwn in right f Canada r by the Prvince f British Clumbia r ther similar emplyment; and b) A signed undertaking agreeing t restrict yur practice as a veterinarian in British Clumbia as an emplyee f the Crwn in right f Canada r as an emplyee f the Prvince f British Clumbia (see attachment at the end f the applicatin fr the frm f undertaking). 6. I have received a Certificate f Qualificatin (CQ) that was assessed in the English language frm the Natinal Examining Bard (NEB) f the Canadian Veterinary Medical Assciatin (CVMA): YES Date f CQ: NO Revised t 27 September

4 Applicatin fr Registratin If yu answered YES then yu must prvide a true cpy certified by a cmmissiner f aths r ntary public in Canada f yur CQ t the CVBC, r yu can have the NEB prvide a cpy f yur CQ directly t the CVBC. If yu answered NO because yu have nt yet received a CQ but yu have passed all the qualifying NEB exams in English and submitted any ther dcumentatin required by the NEB t be issued a CQ then have the NEB prvide prf directly t the CVBC that a CQ will be issued.. If yu answered NO because yur CQ was assessed in the French language and yu did nt graduate frm an accredited r acceptable veterinary schl that prvided instructin in English, r at the time f applicatin t the CVBC yu were registered in anther prvince and yu were required t pass a prir equivalent English language prficiency assessment because yu were frm an accredited r acceptable veterinary schl that did nt prvide instructin in English, then yu must prvide prf t the CVBC that yu are prficient in the English language at a level prescribed the bylaws, Part 2 Registratin, s (2) Private practice registratin criteria and requirements. Yu must prvide a cpy f the reprt f yur English language scres certified by a cmmissiner f aths r ntary public in Canada. Revised t 27 September

5 Applicatin fr Registratin 7. My full veterinary emplyment histry (attach additinal sheets if necessary): Place f emplyment: Lcatin: Frm: T: Descriptin f emplyment: Name f supervisr r emplyer fr cntact purpses: Place f emplyment: Lcatin: Frm: T: Descriptin f emplyment: Name f supervisr r emplyer fr cntact purpses: 8. I am, r was previusly, registered r licensed t practice veterinary medicine, in Canada, including BC, and frm any freign jurisdictins (attach additinal sheets if necessary). Jurisdictin Frm T Jurisdictin Frm T Jurisdictin Frm T Yu must prvide an riginal (r a cpy certified by a cmmissiner f aths r ntary public in Canada) f the fficial Letter f Gd Standing as defined in the bylaws, s. 2.1 (17), Definitins ) frm each jurisdictin where yu are r were licensed. Fr each jurisdictin that did nt require yu t be licensed, yu must have the apprpriate fficial prvide a letter t the CVBC cnfirming that yu did nt require a license. Revised t 27 September

6 Applicatin fr Registratin 9. I declare that I am nt subject t investigatin, review r ther prceeding by a regulatry bdy in British Clumbia r in anther prvince f Canada r a freign jurisdictin that culd result in my entitlement t practice as a veterinarian being cancelled r suspended. Yes N (If yu have been investigated, remediated r disciplined elsewhere in cnnectin with yur veterinary practice, please attach a full written explanatin f the circumstances) 10. I declare that my entitlement t practice as a veterinarian has nt been cancelled r suspended by a regulatry bdy in British Clumbia, in anther prvince in Canada, r a freign jurisdictin at any time: Yes N (If yur licence t practice has been cancelled r suspended, please attach a full written explanatin f the circumstances) 11. I declare that my entitlement t practice as a veterinarian has nt been vluntarily relinquished t a regulatry bdy in British Clumbia, anther prvince in Canada r a freign jurisditin with the effect f preventing the cmmencement r cmpletin f an investigatin, review r ther prceeding by that bdy that culd have resulted in my entitlement t practice in British Clumbia, anther prvince f Canada, r the freign jurisdictin being suspended r cancelled: Yes N (If yu have vluntarily relinquished yur licence t practice elsewhere, please attach a full written explanatin f the circumstances) 12. I declare that I have nt been charged r cnvicted f a criminal ffence. Yes N (If yu have been charged r cnvicted, please attach a full written explanatin f the circumstances and an riginal, r cpy certified by a cmmissiner f aths r ntary public in Canada, f a natinal criminal recrd check frm the plice agency. The natinal criminal recrd check cannt be frm a gvernment department, Visa r passprt fficial frm that jurisdictin. Internet searches are nt acceptable). 13. I prvide the fllwing additinal persnal infrmatin, which is cllected fr precise identificatin and statistical purpses. Sex: Male Female Date f birth: Place: City Cuntry Gvernment issued current identificatn; tw pieces, ne f which must include a pht: Driver s License Prvincial ID Passprt Other: Revised t 27 September

7 Applicatin fr Registratin 14. I agree that if I am granted registratin and while s registered by the Cllege f Veterinarians f British Clumbia, that I will act in accrdance with the Veterinarians Act f British Clumbia and the bylaws. I authrize the registrar f the Cllege f Veterinarians f British Clumbia t btain infrmatin frm any ther regulatry bdy cncerning current r past registratin, including particulars abut cmplaint investigatins (whether dismissed r leading t a cnsent reslutins) and disciplinary r remedial actins. Further, I authrize thse agencies, bdies r individuals pssessing such infrmatin t prvide it upn request t the registrar f the Cllege f Veterinarians f British Clumbia, including withut limitatin, Canadian federal r prvincial and American federal r state plice agencies r any regulatrs f veterinary medical and health prfessinals. 16. I declare that all infrmatin included in this Applicatin fr Registratin Frm and the accmpanying materials is true, accurate and verifiable t the best f my knwledge. Declared befre me at In the jurisdictin f This Day f, 20 Cmmissiner f Oaths r Ntary Public in Canada fr the Signature f Applicant Prvince f Revised t 27 September

8 Applicatin fr Registratin Undertaking fr Temprary registratin fr an external licensed veterinarian I,, prvide the fllwing undertaking t the Cllege f Veterinarians f British Clumbia (CVBC), pursuant t s f the CVBC Bylaws: I have read, understand and will cmply with the Act, the bylaws and any applicable cde r standards. I will restrict my Temprary registratin fr an external licensed veterinarian t the fllwing active class f registratin (please mark ne nly): Private Practice Public Sectr Specialty Private Practice I agree t restrict my temprary practice in accrdance with s (4) t a maximum f 30 nn cnsecutive days fr each registratin. I agree t maintain a lg recrding the date(s) and practice facility names where I wrked and t prvide a cpy t the registrar upn request. I understand that any breach f this undertaking may result in disciplinary cnsequences by the CVBC. Signed this day f mnth, 20 Applicant s signature: Revised t 27 September

9 Applicatin fr Registratin Undertaking fr Specialty Private Practice I,, prvide the fllwing undertaking t the Cllege f Veterinarians f British Clumbia (CVBC), pursuant t s f the CVBC Bylaws: I have read, understand and will cmply with the Act, the bylaws and any applicable cde r standards. I will restrict my Specialty Private Practice registratin in accrdance with the scpe f the diplmate certificate which I hld frm the Advisry Bard n Veterinary Specialties (ABVS), as evidenced by the attached letter frm diplmate bard f the ABVS. I will prmptly ntify the CVBC f any future changes r alteratins t my ABVS diplmate status. I understand that any breach f this undertaking may result in disciplinary cnsequences by the CVBC. Signed this day f mnth, 20 Applicant s signature: Revised t 27 September

10 Applicatin fr Registratin Undertaking fr Public Sectr I,, prvide the fllwing undertaking t the Cllege f Veterinarians f British Clumbia (CVBC), pursuant t s f the CVBC Bylaws: I have read, understand and will cmply with the Act, the bylaws and any applicable cde r standards. I have prvided prf f emplyment as a veterinarian in British Clumbia by the Crwn in right f Canada r by the Prvince f British Clumbia r ther similar emplyment. I will restrict my Public Sectr registratin t practice as a veterinarian in British Clumbia as an emplyee f the Crwn in right f Canada r by the Prvince f British Clumbia r ther similar emplyment. I understand that any breach f this undertaking may result in disciplinary cnsequences by the CVBC. Signed this day f mnth 20 Applicant s signature: Revised t 27 September

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