Social Work Profession General Regulations

(a) a mailing address and telephone number for the applicant;

(b) a photograph of the applicant clearly showing the applicant’s face, taken within six months of the application;

(c) proof that the applicant is entitled to work in Canada;

(d) information about the languages written and spoken by the applicant;

(e) information in respect of the applicant’s prospective employment or practice as a registered social worker or licensed social worker in the Northwest Territories, including

(f) a resume including all employment history relevant to the practice of social work;

(g) if the applicant is registered as a registered social worker in a province or territory, or is otherwise registered and authorized to engage in the practice of social work in a province or territory, proof that the applicant’s registration is in good standing and meets the criteria referred to in subparagraphs 2(b)(i) and (ii);

(h) if the applicant is not registered in a province or territory and is applying for registration as a registered social worker,

(i) if the applicant is not registered in a province or territory and is applying for registration as a licensed social worker, a copy of the diploma or certificate from a program referred to in subparagraph 5(a)(ii) of the Act;

(j) information about each current and previous registration authorizing the applicant to engage in the practice of social work in the Northwest Territories or any other jurisdiction, including dates of registration, class of registration, periods of active practice, any restrictions in respect of practice, any periods of suspension or cancellation, and any revocations;

(k) information about each application by the applicant for registration that has been refused in the Northwest Territories or any other jurisdiction;

(l) information about a settlement or judgment in any civil law suit that relates to the applicant’s practice as a registered social worker or licensed social worker in the Northwest Territories or any other jurisdiction;

(m) the results of a criminal record check obtained from the Royal Canadian Mounted Police and dated not more than six months before the date the application is submitted;

(n) information about any conviction of the applicant for an offence under any law in any jurisdiction that may be relevant to the applicant’s practice as a registered social worker or licensed social worker;

(o) information about any physical, mental or medical condition, including an addiction, of the applicant that may affect the ability of the applicant to practice as a registered social worker or licensed social worker;

(p) a statement signed by the applicant, in a form approved by the Registrar, confirming the information provided by the applicant in the application form and supporting documentation is true.

(a) information satisfactory to the Registrar confirming the identity of the registrant;

(b) a mailing address and telephone number for the registrant;

(c) information in respect of the registrant’s employer and place of employment, or the registrant’s practice and place of practice;

(d) the registrant’s business address and business telephone number;

(e) in any year where required under subsection 8(2), a statement signed by the registrant, in a form approved by the Registrar, confirming the registrant’s compliance with continuing competency requirements;

(f) information about each finding against the registrant of unprofessional conduct, including professional misconduct, incompetence to practice, incapacity to practice, or lack of fitness to practice as a registered social worker or licensed social worker in the Northwest Territories or any other jurisdiction;

(g) information about any investigation, proceeding or finding in respect of the conduct or competence of the registrant related to the registrant’s practice as a registered social worker or licensed social worker in the Northwest Territories or any other jurisdiction;

(h) information about a settlement or judgment in any civil law suit that relates to the registrant’s practice as a registered social worker or licensed social worker in the Northwest Territories or any other jurisdiction;

(i) information about any conviction of the registrant for an offence under the Criminal Code or any other law in any jurisdiction that may be relevant to the practice of a registered social worker or licensed social worker;

(j) information about any physical, mental or medical condition, including an addiction, of the registrant that may affect the registrant’s ability to practice as a registered social worker or licensed social worker;

(k) a statement signed by the registrant, in a form approved by the Registrar, confirming the information provided by the registrant in the application form and supporting documentation is true.