Statutory Declaration Form 2

STATUTORY DECLARATION (FORM 2)
F4-32007
260-3480 Gilmore Way
Burnaby, BC, V5G 4Y1
Tel: 778-373-3101
Toll-free within BC: 1-877-373-2201
Email: [email protected]
In the matter of an application for registration in the College of Licensed Practical Nurses of British Columbia
(CLPNBC) in the province of British Columbia, Canada
I,
of
city/ province/ country
do solemnly declare that:
1. I have not been charged or convicted in Canada or elsewhere of any criminal offence except as follows:
2. My past conduct does not demonstrate any pattern of incompetency or untrustworthiness which would
make registration contrary to the public interest;
3. I am a person of good character and fit to practise (I am not mentally or physically impaired by a condition
or addiction);
4. My entitlement to practise nursing has not been limited, restricted, or subject to conditions in any
jurisdiction at any time except as follows:
5. At the present time, no investigation, review or proceeding is taking place in any jurisdiction with respect to
my licensure or registration in that jurisdiction except as follows:
6. I am aware of and will comply with the ,ĞĂůƚŚWƌŽĨĞƐƐŝŽŶƐĐƚ
Health Professions Act and the Regulation and CLPNBC bylaws and
the CLPNBC Standards of Practice.
And I make this solemn declaration, conscientiously believing it to be true and knowing that it is of the same
force and effect as if made under oath.
Signature of Applicant
DECLARED before me at the city of
In
this
Country
day of
date
A Commissioner for taking Affidavits
month
20____.
year
STATUTORY DECLARATION FORM
F4-32007
HEALTH PROFESSIONS ACT
The Health Professions Act (HPA) is the primary legislative authority under which CLPNBC carries out its mandate to
protect the public through the regulation of LPN practice. The HPA is written and enacted by government.
All regulated health professions in BC (except emergency medical assisting) are regulated through the HPA. The
Board is responsible for ensuring that CLPNBC meets the objects of a College as specified in the HPA.
Further information can be found on the BC Ministry of Health Professional Regulation Page.
CLPNBC BYLAWS
CLPNBC has authority under the HPA to develop bylaws for the College to address its operation and administration.
Bylaws are written by the College and approved by government and therefore have the authority of law. Bylaws
regulate the Board’s administration of the internal affairs of the College and contain information regarding: Board of
College, College Administration, College Records, Registration, Inspections, Inquiries and Discipline, Registrant
Records for Self Employed Registrants.
NURSES (LICENSED PRACTICAL) REGULATION
The Ministry of Health has been implementing significant changes to the BC health professions regulatory
framework. More information about this framework can be found in Safe Choices: A New Model for Regulating
Health Professions in British Columbia.
Under the new regulatory framework, the Ministry of Health writes and assigns all regulated health professions their
own regulation under the HPA. The regulation sets out:
•
•
•
Scope of Practice
Title Protection
Restricted Activities
STANDARDS OF PRACTICE
CLPNBC has developed standards of practice defining the values of the nursing profession (professional standards),
the requirements related to specific aspects of nursing practice (practice standards) and the activities a LPN is
educated and authorized to perform (scope of practice). More information on this can be found at
https://www.clpnbc.org/Practice-Support-Learning.aspx.
CLPNBC Authority: Under the terms of the Health Professions Act (“the Act”), the College of Licensed Practical Nurses of BC (CLPNBC) has
the mandate to regulate the profession of practical nursing in the public interest. “The Act” states that anyone who holds themselves out to
be a Licensed Practical Nurse (LPN) and does not hold current registration with the CLPNBC commits an offence. Do NOT use the title LPN, PN,
Licensed Practical Nurse, Practical Nurse or nurse until you have been notified by the CLPNBC that you are registered as a practising LPN. If
you hold limited, interim, temporary or non-practising registration, your title must reflect your registration status.