Hardworking FH Professional Seeking Weekend/Casual Roles
Resume:
For up to date information about the Expedited Licensing Process for Nurses Licensed in Designated Jurisdictions please visit the NSCN website. Name: NSCN Application No:
Initial Application Registration Checklist
APPLICATION &KZD hW d :
In your NSCN Registrant Portal•please update the following sections of your application: Provide Two Proof of Name Documents:
x In your application, upload two different proof of name documents. x These documents must
o Be government issued
o Match exactly the name on your application
o Include your date of birth
o Be current (i.e., not expired)
Provide your full legal name:
x Update your name to include your legal name, including middle name School of Nursing:
x In your application, provide the name and address (City/State/Country) of the school of nursing where you completed your entry to practice nursing program. Employment:
x In your application, add •• • •employer(s) name and address (City/State/Country) where you•worked as a paid RN since 201• (include only paid RN work). o For more information click here.
ractice:
x In your application, ĚĞƚĞƌŵŝŶĞ LJŽƵƌ ĐƵƌƌĞŶĐLJ ŽĨ ƉƌĂĐƚŝĐĞ ĂŶĚ ŽŶůLJ ƌĞƉŽƌƚ ƚŚĞ paid RN* practice hours you have worked͘ This information must match the RN employment history provided. &Žƌ ŵŽƌĞ ŝŶĨŽƌŵĂƚŝŽŶ ĐůŝĐŬ ŚĞƌĞ͘ x >Ğƚ ƵƐ ŬŶŽǁ ŝĨ LJŽƵ ŚĂǀĞ ĐŽŵƉůĞƚĞĚ Ă EƵƌƐŝŶŐ ZĞͲ ŶƚƌLJ WƌŽŐƌĂŵ ŝŶ ĂŶĂĚĂ͘ ŵĂŝů ƚŚŝƐ ŝŶĨŽƌŵĂƚŝŽŶ ƚŽ ƌƌƚΛŶƐĐŶ͘ ĐĂ͘
* Only include paid RN practice hours͘
Licensure:
x In your application, identify all provinces, states or countries where you hold, or have held a nursing licence.
x The Registration number must be numeric
x The name of the Regulatory Body must be your designation – i.e., registered nurse, registered midwife
tĞ ƌĞƋƵŝƌĞ ĂĚĚŝƚŝŽŶĂů ŝŶĨŽƌŵĂƚŝŽŶ ƚŽ ĐŽŶƚŝŶƵĞ ƉƌŽĐĞƐƐŝŶŐ LJŽƵƌ ĂƉƉůŝĐĂƚŝŽŶ͘ dŚĞ ŝŶĨŽƌŵĂƚŝŽŶ ǁĞ ŶĞĞĚ ŚĂƐ ďĞĞŶ ŝĚĞŶƚŝĨŝĞĚ ĨŽƌ LJŽƵ ǁŝƚŚ Ă ĐŚĞĐŬ ŵĂƌŬ ͞ я͟ ŝŶ ƚŚĞ ĂƚƚĂĐŚĞĚ ĐŚĞĐŬůŝƐƚ͘ dŽ hƉĚĂƚĞ zŽƵƌ ƉƉůŝĐĂƚŝŽŶ
ϭ͘ >ŽŐ ŝŶƚŽ ƚŚĞ ƌĞŐŝƐƚƌĂŶƚ ƉŽƌƚĂů ƵƐŝŶŐ LJŽƵƌ ĞŵĂŝů ĂŶĚ ƉĂƐƐǁŽƌĚ͘ Ϯ͘ ůŝĐŬ ƚŚĞ ͞ hƉĚĂƚĞ͟ ďƵƚƚŽŶ ƚŽ ŽƉĞŶ LJŽƵƌ ĂƉƉůŝĐĂƚŝŽŶ ĨŽƌ ĞĚŝƚƐ͘ ϯ͘ ĚĚ ƚŚĞ ŵŝƐƐŝŶŐ ŝŶĨŽƌŵĂƚŝŽŶ Žƌ ŵĂŬĞ ƌĞƋƵŝƌĞĚ ĐŚĂŶŐĞƐ ƚŽ Ăůů ƋƵĞƐƚŝŽŶƐ ƌĞƋƵĞƐƚĞĚ ŽŶ ƚŚĞ ĐŚĞĐŬůŝƐƚ͘ ϰ͘ ůŝĐŬ ƚŚĞ ͞ ^Ƶďŵŝƚ͟ ďƵƚƚŽŶ ƚŽ ƌĞƚƵƌŶ ƚŚĞ ĐŽƌƌĞĐƚĞĚ ĂƉƉůŝĐĂƚŝŽŶ͘ ϱ͘ ^ĞŶĚ ƚŚŝƐ ĐŚĞĐŬůŝƐƚ ďĂĐŬ ŝŶ ĂŶ ĞŵĂŝů ƚŽ ZZdΛŶƐĐŶ͘ ĐĂ ƚŽ ĂĚǀŝƐĞ E^ E ŽĨ ĐŽŵƉůĞƚŝŽŶ͘ tĞ ǁŝůů ĐŽŶƚŝŶƵĞ ƉƌŽĐĞƐƐŝŶŐ LJŽƵƌ ĂƉƉůŝĐĂƚŝŽŶ ǁŚĞŶ ǁĞ ŚĂǀĞ ƚŚĞ ƌĞƋƵŝƌĞĚ ŝŶĨŽƌŵĂƚŝŽŶ͘ Page 2 of 4
For up to date information about the Expedited Licensing Process for Nurses Licensed in Designated Jurisdictions please visit the NSCN website. W d d/KE KZ Z ^WKE dK d K>>Kt/E'͗
Name Change Documents:
x If applicable, please ƐĞŶĚ a copy of your legal
name change document (e.g., marriage
certificate) to this email.
Required
Not Required
What is the date that you last
practiced as a paid RN?
Date YYYY-MM-DD:
Identify in which country(ies) you have lived during the last 2 calendar years.
x Please list most recent first.
1.
2.
Have you completed a competence assessment for a
Canadian Regulatory Body͕ ĨŽƌ ƚŚĞ ĚĞƐŝŐŶĂƚŝŽŶ LJŽƵ ĂƌĞ ĂƉƉůLJŝŶŐ ĨŽƌ?
o A competence assessment is an assessment of your nursing knowledge, skills and judgements using tools such as objective structured clinical examination (OSCE) and/or written tests (e.g. /ŶƐƉŝƌĞ 'ůŽďĂů
ƐƐĞƐƐŵĞŶƚ͕ NCAS͕ dŽƵĐŚƐƚŽŶĞ).
YES NO
When YYYY-MM-DD:
Where:
tŚĂƚ ǁĂƐ ƚŚĞ ĚĞĐŝƐŝŽŶ ďLJ ƚŚĞ Z ͍,ĂǀĞ LJŽƵ ĐŽŵƉůĞƚĞĚ Žƌ ĂƌĞ ĞŶƌŽůůĞĚ ŝŶ Ă ďƌŝĚŐŝŶŐ ĞĚƵĐĂƚŝŽŶ ĂƐ Ă ƌĞƐƵůƚ ŽĨ Ă
ŶƵƌƐŝŶŐ ĐŽŵƉĞƚĞŶĐĞ ĂƐƐĞƐƐŵĞŶƚ͍
YES NO
Ύ/& z ^͕ ƉůĞĂƐĞ ĂƌƌĂŶŐĞ ǁŝƚŚ ƚŚĞ Z ƚŽ ƉƌŽǀŝĚĞ E^ E ǁŝƚŚ Ă ĐŽŶĨŝƌŵĂƚŝŽŶ ŽĨ ƉƌŽŐƌĂŵ ĐŽŵƉůĞƚŝŽŶ ĨŽůůŽǁŝŶŐ Ă ĐŽŵƉĞƚĞŶĐĞ ĂƐƐĞƐƐŵĞŶƚ͘ Z dZ d/KE EXAM:
1. Are you applying to take the exam through NSCN? YES NO 2. If you answered “no”, please put a checkmark “ ” beside your reason:
“ ” your
response
Potential Reasons
I am not ready to take the ƌĞŐŝƐƚƌĂƚŝŽŶ ĞdžĂŵ
x it is important that you indicate on your application that you want to take the Ğxam x You are not required to pay ĨŽƌ ƚŚĞ exam invoice until you are ready to take it I have already passed the ĞdžĂŵ through another regulatory body (RB). /ŶĚŝĐĂƚĞ ƚŚĞ ĞdžĂŵ ŝŶ ƚŚĞ ŶĞdžƚ ƉĂŐĞ͘ x If this is the case, please ask the RB to provide one of the following directly to NSCN: Ă͘ Verification of Registration
ď͘ a letter or official document showing you have passed the ƌĞŐŝƐƚƌĂƚŝŽŶ ĞdžĂŵ͘ I am planning to take ƚŚĞ ƌĞŐŝƐƚƌĂƚŝŽŶ ĞdžĂŵ ͗
If this is the case, you are responsible to inform NSCN of all of your exam results; ask the RB to provide one of the following directly to NSCN:
Ă͘ Verification of Registration
ď͘ a letter or official document showing you have passed the ƌĞŐŝƐƚƌĂƚŝŽŶ ĞdžĂŵ Other (please explain):
ƌĞ LJŽƵ ĐƵƌƌĞŶƚůLJ ĞŵƉůŽLJĞĚ ĂƐ ĂŶ ZE͍
z ^ EK
ƚŚƌŽƵŐŚ ƚŚĞ ĨŽůůŽǁŝŶŐ ZĞŐƵůĂƚŽƌLJ ŽĚLJ͗
Page 3 of 4
For up to date information about the Expedited Licensing Process for Nurses Licensed in Designated Jurisdictions please visit the NSCN website. TESTING ACCOMMODATIONS
You should know:
x Testing accommodations have nothing to do with NSCN finding you a place to stay while you take tŚĞ ƚĞƐƚ ŝ͘ Ğ͘ ŶŽƚ Ă ŚŽƚĞů ĂĐĐŽŵŵŽĚĂƚŝŽŶͿ͘
x Testing accommodations has nothing to do with immigration or employment. x Exam takers, who believe the administration of the ƚĞƐƚ E > yͬ WEZ Ϳ Ěiscriminates against them on a ground prohibited by the Nova Scotia Human Rights Act, may request in writing that they be provided accommodation to eliminate or reduce the effects of the prohibited discrimination during the administration of the exam. (for example, increased font size for the visually impaired, extra exam time for a diagnosed learning disability)
x You must provide evidence that one or more of the grounds listed in the Human Rights Act prevents you from taking the examination in the usual method and/or environment x Often this applies to people who had testing accommodations during their nursing program Are you applying for testing accommodations based
on one of the grounds in the Nova Scotia Human
Rights Act (for example do you have a physical or
mental disability)?
YES
email registraƟon@nscn.ca for the required forms
NO
<ŝŶĚůLJ ĐŽŵƉůĞƚĞ ƚŚĞ ĨŝĞůĚƐ ďĞůŽǁ͕ ƚŽ ĚĞƚĞƌŵŝŶĞ ŝĨ LJŽƵ ŚĂǀĞ ĂƚƚĞŵƉƚĞĚ ĂŶLJ ŽĨ ƚŚĞƐĞ ƌĞŐŝƐƚƌĂƚŝŽŶ ĞdžĂŵƐ ŝŶ
ĂŶĂĚĂ͕ dŚĞ h^͕ Žƌ ƵƐƚƌĂůŝĂ?
Type of Exam /Ĩ z ^͕ /ŶĚŝĐĂƚĞ ƌĞƐƵůƚƐ:
Fail/ Pass
Most Recent Attempt:
YYYY-MM-DD
Number of Attempts
NCLEXͲZE
Through which Regulatory Body:
OIIQͬ ZE
Through which Regulatory Body:
WNREͬ Z yͲWE
K// Y
Through which Regulatory Body:
ƚƚĞŵƉƚĞĚ͗ z ^ͬ EK
z ^ EK
z ^ EK
z ^ EK
Ύ/& zKh, s W Ez K& d y D Ks ͕ /E d, EhZ^/E E d/KE zKh Z WW>z/E'
&KZ͕ ƉůĞĂƐĞ ĂƌƌĂŶŐĞ ĨŽƌ ƚŚĞ ZĞŐƵůĂƚŽƌLJ ŽĚLJ Z Ϳ ƚŽ ƐĞŶĚ ƌĞƐƵůƚƐ ƚŽ E^ E͘ Page 4 of 4
VERIFICATION OF REGISTRATION:
Please provide We have received your VOR Not Required x A Registration/Licensure Verification Form must be provided to NSCN directly from your regulatory body; or
x If you have received an NNAS Advisory Report and the verification you provided to NNAS is less than two years old, port your NNAS Advisory Report to NSCN
x once ported, provide us with the six-digit NNAS Advisory Report Application Number x NOTE: You are not required to apply to NNAS
6 Digit NNAS Application Number:
CRIMINAL RECORD CHECK(S):
x tĞ ǁŝůů ůĞƚ LJŽƵ ŬŶŽǁ ǁŚĞŶ ƚŽ ƐƵďŵŝƚ ƚŚŝƐ ĚŽĐƵŵĞŶƚ͘ Criminal Record Check (CRC) ǁŝůů ďĞ ƌĞƋƵŝƌĞĚ ǁŚĞŶ LJŽƵ ďĞĐŽŵĞ ĞůŝŐŝďůĞ ĨŽƌ Ă ŽŶĚŝƚŝŽŶĂů >ŝĐĞŶƐĞ Žƌ Ă WƌĂĐƚŝƐŝŶŐ >ŝĐĞŶĐĞ͘ x dŚŝƐ ĚŽĐƵŵĞŶƚ ŝƐ ŽŶůLJ ǀĂůŝĚ ǁŝƚŚŝŶ ϲ ŵŽŶƚŚƐ͘
x >ĞĂƌŶ ŵŽƌĞ ĂďŽƵƚ ƚŚŝƐ ĚŽĐƵŵĞŶƚ ŚĞƌĞ͗ ƌŝŵŝŶĂů ZĞĐŽƌĚ ŚĞĐŬ ͮ EŽǀĂ ^ĐŽƚŝĂ ŽůůĞŐĞ ŽĨ EƵƌƐŝŶŐ
ŶƐĐŶ͘ ĐĂͿ
/Ĩ LJŽƵ ĂƌĞ ŝŶ ĂŶĂĚĂ͕ ƉůĞĂƐĞ ƚĞůů ƵƐ
ƚŚĞ ĚĂƚĞ LJŽƵ ĂƌƌŝǀĞĚ ŝŶ ƚŚĞ ĐŽƵŶƚƌLJ͍
/ Ăŵ ĐƵƌƌĞŶƚůLJ ůŝǀŝŶŐ ŽƵƚƐŝĚĞ ŽĨ ĂŶĂĚĂ͘
dŚŝƐ ƐĞĐƚŝŽŶ ŝƐ ƚŽ ďĞ ĐŽŵƉůĞƚĞĚ ďLJ E^ E ^ƚĂĨĨ͗
ĂƚĞ ŽĨ ZĞǀŝĞǁ͗
^ĞŶƚ ďLJ͗
For up to date information about the Expedited Licensing Process for Nurses Licensed in Designated Jurisdictions please visit the NSCN website.
Contact this candidate