Nova Scotia College of Respiratory Therapists

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Class of Registration

Active Practice: Active Practice _ Has met basic requirements of the profession and is able to practise in the profession in Nova Scotia.

Temporary: Temporary - Currently licensed in another jurisdiction and will be temporarily (less than 12 months) working in Nova Scotia.

Non-Practicing: Non-Practising _ Member of the College who was eligible for an active-practice licence but is not now practicing respiratory therapy in the province

Temporary Graduate: Graduate _ Practising under supervision for up to 18 months until successful completion of the entry to practice exam.

Temporary - Pandemic Support: Temporary - Retired or licensed in another jurisdiction and will be temporarily supporting pandemic response efforts in Nova Scotia

Date Licence is Needed

To Date

Demographics

Aboriginal Status

Yes

Aboriginal Status

Are you a member of a visible minority?

Yes

Visible Minority

Members Data

Given Name(s)

Surname

Previous Name

if applicable.

Country

Province

Postal Code

City

Address

Phone

Date of Birth

Gender

Citizenship Status
Documentation verifying your citizenship status must accompany this application form.

Citizenship

Canadian Citizen

Permanent Resident/Landed Immigrant of Canada

Authorized under the Immigration Act

Language Proficiency
If your first language and your language of RT instruction is not English, documentation of fluency is required.

First Language

Language of RT Training

Preferred Language of Correspondence from the College

Will you be able to provide professional services in (Check all that apply)

English

French

Other

Other language

Respiratory Therapy Education

Name of Institution

Program Type

Degree/Diploma/Certificate Obtained

Year Started

Year Completed

Address

City

Province

Postal Code

Country

Other Education

Name of Institution

Field of Study

Program Type

Degree/Diploma/Certificate Obtained

Year Started

Year Completed

Address

City

Province

Postal Code

Country

Professional Registration and Conduct
Please complete the attached Registration/Licensure Data Verification Form to support your status or registration with a regulatory/licensing organization.

Fill in ALL Professional Registration fields, or select Not Applicable

Not Applicable

Regulatory/Licensing Body

Province/State

Country

Reg./License No.

Date Registration Held From

Date Registration Held To

Self Declarations
If your answer is YES to any of the following questions, you MUST provide full details in the text area provided.

Have you been found guilty of a criminal offence in Canada or in any jurisdiction outside Canada?

Yes No

Please provide details

Have you been disciplined, suspended, required to resign or terminated, from employment as a health professional for unprofessional behavior, misconduct, incapacity, incompetence, negligence or disciplinary action?

Yes No

Please provide details

Have you ever had your certificate of registration or license suspended, removed or revoked by any professional licensing or registration body?

Yes No

Please provide details

Have you previously applied for registration or have you previously been registered with the Nova Scotia College of Respiratory Therapists?

Yes No

Please provide details

Have you been the subject of any professional misconduct, incompetence or incapacity proceeding by any health profession licensing or registration body?

Yes No

Please provide details

Is there any event, circumstance, condition or matter not disclosed in your replies to the preceding questions relevant to your competence, conduct or physical or mental capacity that might be an impediment to your ability to function as a Respiratory Therapist?

Yes No

Please provide details

Employment
Please note that beginning any Respiratory Therapy employment (in Nova Scotia), including clinical orientation, prior to being issued a licence to practice by the College is in contravention of the Respiratory Therapy Act and may impact on the approval of your application.

What is your current employment status?

Primary Employer
Please provide details of your current Respiratory Therapy employment or volunteering positions.

From Date

Employer Name

Country

Province

Postal Code

City

Address

Phone

Fax

Employer Type

Employment Time Status

Employment Category

Job Title

Position Type

Primary Area of Practice

Division/Site/Campus

Department

Name of Manager/Supervisor

Title of Manager/Supervisor

Manager/Supervisor Phone

Manager/Supervisor Email

Have you ever been “engaged in the practice” (see definitions) of Respiratory Therapy in any jurisdiction at any time in the past?

Yes No

Respiratory Therapy Employment History
Please provide details of your past Respiratory Therapy employment or volunteering positions.

Number of hours worked in the past 4 years

From Date

To Date

Employer Name

Country

Province

Postal Code

City

Address

Phone

Fax

Employer Type

Employment Time Status

Employment Category

Job Title

Position Type

Primary Area of Practice

Division/Site/Campus

Department

Name of Manager/Supervisor

Title of Manager/Supervisor

Manager/Supervisor Phone

Manager/Supervisor Email

Have you recently been offered a position as a Respiratory Therapist? If your answer is “YES”, please complete the following Employment Data section:

Yes No

Proposed Employment

Proposed Start Date

Employer Name

Country

Province

Postal Code

City

Address

Phone

Fax

Employer Type

Employment Time Status

Employment Category

Job Title

Position Type

Primary Area of Practice

Division/Site/Campus

Department

Name of Manager/Supervisor

Title of Manager/Supervisor

Manager/Supervisor Phone

Manager/Supervisor Email

Please describe briefly what your job duties will be and/or the area in which you will practice.

Certified Area of Speciality

Supporting Documents

I will be uploading scanned documents with this application:

Yes No

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* indicates document is required

* Proof of Citizenship

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* Vulnerable Sector / Criminal Record Check

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Payment of Fees

In order for your application to be processed you must submit all applicable fees.

Application fee: $75.00 The application fee is non-refundable
Registration fee: The College registration year runs from April 1 to the end of March. For applicants who have never been registered with the College, registration fees are prorated at $40.00/month

Former members returning to the College are required to pay the full registration fee of $475.00 regardless of the month in which the application is made.

Choose Your Method of Payment

Credit Card

Send a cheque via mail

No Payment Required

Upon submission, you will be asked to provide credit card information.

Upon submission, you will be given mailing details.

No payment is required for this submission.

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Initial Registration Application

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