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Application for Full Registration(Application to Become a Registered Social Worker (RSW))

Applicants must read through this entire package before starting to complete it. Applications cannot be

considered until the requirements of each part are complete and have been received by the College.

Valid Email: Once your application has been received by the College, it generally takes 5-6 weeks for the College to process your application. After processing your application, the College will provide an

update on your application status via email. Please provide an up-to-date email address in Section 1

on page 3 and make sure to check your inbox as well as spam/junk folder frequently. If you see the

College’s email in your spam/junk folder, please mark it as a safe sender.

Application Requirements:

For instructions and details regarding each part of the application requirements, please see Index A on page 8 of this application form.

1. Application form2. Consent to a Criminal Record Check form3. Copy of two pieces of identification4. Original copy of Police Information Check (or other applicable criminal record check(s))

a. This is a requirement separate from and in addition to completing the 'Consent to a CriminalRecord Check form' listed as item 2 above.

5. Resume6. Official transcript7. Two reference forms8. Verification of Registration/Licensure form (if required)

Licensure Examination:

Upon receiving and approving a completed application, the College will authorize the applicant to

write a competency-based licensure exam. The exam level will be determined according to the

applicant’s academic credential and will be either the ASWB Bachelor level or Master level

examination. Successful completion of the exam is a requirement for registration with the College.

Applicants licensed in another Canadian jurisdiction are encouraged to contact the College.

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Application for Full Registration(Application to Become a Registered Social Worker (RSW))

Section 1 – Personal Information

Legal Last Name:

Legal First Name:

Middle Name:

Date of Birth: Sex: Male Female

Preferred First Name:

(MM/DD/ YYYY) (if different from legal first name)

Other Names Used or Have Used: (e.g. maiden name, birth name, or previous married name)

Last Name: First: Middle:

Last Name: First: Middle:

Mailing Address:

City: Province: Country: Postal Code:

Phone #:Personal Email Address:

Section 2 – Employment Information

If you are employed in a social work related position, please fill out this section. If you are not yet employed, you have to provide this information prior to beginning work. If you are employed in more than one location, whether part-time, full-time or in private practice, please include an additional piece of paper with all the details listed below for each location of employment.

Name of Employer:

Worksite:

Business Address:

City: Province: Country: Postal Code:

Business Phone: Local:

Work email address:

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Section 3 – Educational History List your highest social work degree.

Degree: Year Obtained:

Institution:

Applicants who do not have a social work degree, please contact the College before proceeding.

Section 4 – Professional Affiliations

Regulatory Body: Registration Number:

Regulatory Body: Registration Number:

If you are currently or ever have been registered with any other regulatory body in any profession, please complete the appropriate ‘Verification of Registration' form which can be found on our website.

Section 5 – Professional Conduct Disclosure

a. Have you ever been the subject of a finding of professional misconduct orincompetence?

YES NO

b. Are you currently the subject of a proceeding in relation to professional misconduct, orincompetence?

YES NO

If you have answered yes to either of the questions above, please attach a separate sheet of paper with details of the situation and findings.

Section 6 – Consent to Disclose

The College offers Registrants the choice to have their business address and telephone number listed on the public registry. If you would like your business address and telephone number published please provide consent and details below.

If my application is approved, I consent to the publication of my business address and telephone number to my profile on the College online registry YES NO

Business Address: ___________________________________________________________________________________

Business Phone: ____________________________________

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Section 7 – Application Statement

Canada, Province of British Columbia, in the matter of an application for registration with the British Columbia College of Social Workers

I, of

(Name) (City)

do solemnly declare that:

I have not been convicted in Canada or elsewhere of any offence that, if committed by a person registered under the Social Workers Act, would constitute unprofessional conduct or conduct unbecoming a person registered under these bylaws except as follows:

My past conduct does not demonstrate any pattern of incompetence or untrustworthiness which would make registration contrary to the public interest.

I am a person of good character.

My entitlement to practise social work has not been limited, restricted or subject to conditions in any jurisdiction at any time except as follows:

At the present time, no investigation, review or proceeding is taking place in any jurisdiction which could result in the suspension or cancellation of my authorization to practise social work in that jurisdiction except as follows:

I have read the Social Workers Act of British Columbia, the Bylaws of the British Columbia College of Social Workers made pursuant to that Act.

I will practise at all times in compliance with the Social Workers Act of British Columbia, and the bylaws of the British Columbia College of Social Workers made pursuant to that Act.

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.

The personal information requested on this form is collected under the authority of and will be used for the purpose of administering the registration process under the Social Workers Act. The collection, use and disclosure of personal information are subject to the provisions of the Freedom of Information and Protections of Privacy Act. If you have any questions about the collection, use or disclosure of this information, please contact the Registrar of the BC College of Social Workers at 604-737-4916.

Applicant’s Signature: Date:

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Application Fee Payment Form

Card Number: Expiry Date: M M Y Y

CVD/CVV: __________ (three-digit number on the back of credit card)

Name Printed on Card:

Authorized Signature:

Please complete and submit with your application

Credit Card Holder Contact Information

Last Name: First Name:

Mailing Address:

City: Province: Country: Postal Code:

Phone #: Email Address:

Fee Information

A non-refundable fee of $120.00 is required to process the application

Fees are payable by Visa, MasterCard, money order or cheque

Cheques are payable to the BC College of Social Workers

There is a $25 charge for any cheque returned insufficient funds

If your application is approved, you will receive an email containing an application

approval letter and an invoice for the registration fee, which is separate from the

application fee. Initial registration fee is prorated based on the month of approval.

Amount: $120.00

Payment: Mastercard Visa Cheque Enclosed #

PART 1 – APPLICANT/REGISTRANT INFORMATION

Last Name: Full Middle:

Birth Date:

Full First:

Sex: Male Female Birth Place: (yyyy/mm/dd) (City, Province/State, Country)

OTHER NAMES USED OR HAVE USED: (e.g., maiden name, birth name, or previous married name)Surname: First: Middle:

Surname: First: Middle:

Surname: First: Middle:

Mailing Address:

City: Country: Postal Code:

Contact Phone : ( )

Province:

Canadian Driver Licence # :

PART 2 – ORGANIZATION INFORMATION

Organization Name: BRITISH COLUMBIA COLLEGE OF SOCIAL WORKERS Governing Body

ID Number (provided by the Criminal Records Review Office): 004

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Schedule B IMPORTANT: Please read information and instructions on Page 2.

Criminal Records Review Program

Consent to a CRIMINAL RECORD CHECK

Ministry of Public Safety and Solicitor GeneralPolicing and Community Safety BranchSecurity ProgramsCriminal Records Review Program

Submit Form to:info@bccsw.ca OR BCCSW1420 1200 West 73 Avenue Vancouver, BC V6P 6G5

CONSENT FOR RELEASE OF INFORMATION AND ACKNOWLEDGEMENTS: p I have read and understand the Consent for Release of Information and Acknowledgements on Page 2. I hereby

consent to these terms as indicated by my signature below.p I hereby authorize my organization as indicated in Part 2 - Organization Information to conduct criminal record checks on an ongoing basis,

every five years. I understand that I may contact my organization to withdraw this consent for future criminal record checks.

Applicant SignatureMust be physical signature (digital not accepted)

Date SignedParent or Guardian Signature forApplicant Under 19 Years of Age

x

x

Consent to a Criminal Record Check (Schedule B)

The information requested on this form is collected under the authority of the section 4(1) of the Criminal Records Review Act and section 26(c) of the Freedom of Information and Protection of Privacy Act (FOIPPA). The information provided will be used to fulfill the requirements of the Criminal Records Review Act for the release of criminal records information and is in compliance with the FOIPPA. If you have questions about the collection of your personal information, please contact the Policy Analyst, Criminal Records Review Program, PO Box 9217 Stn Prov Govt, Victoria, BC V8W 9J1 or by phone at 1-855-587-0185.

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INFORMATION and INSTRUCTIONS

Page 1 is set up with 'form fields' so you may complete it at your computer then print the number of copies required. You may also complete the form by hand, but please print clearly using dark ink. Processing delays will result if the form submitted is incomplete, incorrect or if information cannot be read clearly. For more information, contact the British Columbia College of Social Workers at (604) 737-4916.

Schedule B: use if the individual is a) applying for membership or is a registered member of a B.C. governing body listed in Schedule 2 of the Criminal Records Review Act, or b) is a registered student in a post-secondary program with a practicum component involving work with children and/or vulnerable adults. The requesting organization retains the consent form.

CHECKLIST for Applicant/Registrant

I have completed all the applicable sections of the form truthfully, clearly and legibly, and signed and dated it.

I have read and understand the Consent for Release of Information and Acknowledgements and information regarding the Freedom of Information and Privacy Act (FOIPPA) – (outlined below).

I have signed and dated the Consent to a Criminal Record Check form.

I understand the British Columbia College of Social Workers will retain proof of the original form and will submit information from this form to the Criminal Records Review Program for the purposes of the Criminal Records Review Act.

CONSENT FOR RELEASE OF INFORMATION AND ACKNOWLEDGEMENTS PURSUANT TO THE B.C. CRIMINAL RECORDS REVIEW ACT

I hereby consent to a check for records of criminal charges and convictions to determine whether I have aconviction or outstanding charge for any relevant or specified offence(s) under the Criminal Records ReviewAct;

o I hereby consent to a check of all available law enforcement systems, including any local policerecords.

o I hereby consent to a vulnerable sector search to check if I have been convicted of and beengranted a pardon for any sexual offences of the Criminal Records Act.

o I understand a criminal record check under the Criminal Records Review Act is required at leastonce every five years.

o Go to the RCMP website for additional details on vulnerable sector checks: http://www.rcmp-grc.gc.ca/en/faqs-about-vulnerable-sector-checks

I hereby authorize the release to the Deputy Registrar any documents in the custody of the police, the courtand crown counsel relating to an outstanding charge or conviction of any relevant offence as defined underthe Criminal Records Review Act.

Where the results of this check indicate that a criminal record or outstanding charge for a relevant offencemay exist, I agree to provide my fingerprints to verify any such criminal record.

The Deputy Registrar will notify me and my organization that I have an outstanding charge or conviction forany relevant offence(s) and the matter has been referred to the Deputy Registrar;

The Deputy Registrar will determine whether or not I present a risk to physical or sexual abuse to children;

The Deputy Registrar's determination will be disclosed to my organization and it will include consideration ofany relevant offence for which I have received a pardon;

If I am charged with or convicted of a relevant offence at any time subsequent to the criminal record checkauthorized herein, I further agree to report the charge or conviction to my organization and provide myorganization, in a timely manner, with a new signed Consent to a Criminal Record Check form.

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Index A

1. Application Form: All pages of the attached Application form should be completed and sent to the College,including the $120 Application fee payment. This form can be sent to the College by email, fax, or mail.

2. Consent to a Criminal Record Check form: You can find this form attached to this Application form. This is arequirement pursuant to the BC Criminal Records Review Act. Do not take this form to a police detachment.Simply complete this form and send it to the College by email, fax, or mail.

3. Identification: A high quality copy of two (2) pieces of identification. One must be government issued photoidentification. These copies can be sent to the College by email, or mail. For a list of acceptable ID, click here.Applicants born outside Canada must provide proof of Canadian citizenship, permanent residency or work permitwith a copy of both sides of their Canadian immigration status once these documents are available.

4. Police Information Check (this is a requirement separate from and in addition to completing the 'Consent to aCriminal Record Check' form listed as item 2 above): Applicants are required to submit a national or federalcriminal record check from their country of residence. The original copy of the result of the check must be mailedto the College by the applicant if the issuing agency will not send it directly to the College.

a. If your country of residence is Canada, this requirement can be fulfilled by visiting your local policedetachment and requesting a Police Information Check including the vulnerable sector.

b. If your country of residence is the USA, you are required to submit an FBI Identity History SummaryCheck.

c. Criminal record checks are required from any country in which an applicant was a resident or worked asan adult. If citizenship or permanent residency in Canada has been granted and the applicant has notresided outside Canada since the date of issue, the College may accept proof of a Permanent ResidentCard or Canadian Citizenship or Canadian work permit information in lieu of international criminal recordchecks.

d. A criminal record does not automatically disqualify an applicant from registration; however, it is necessaryto provide details of the incident that gave rise to the criminal record.

5. Resume: An up-to-date resume with complete work history pertaining to social services. Applicants may berequired to provide additional information. This can be sent to the College by email, fax, or mail.

6. Official Transcript: An official transcript of your highest social work degree must be mailed directly to theCollege by the awarding institution.

a. If you have completed all the requirements of your degree but are awaiting conferral, please request anofficial ‘Degree Completion Letter’ to be sent directly to the College from the educational institution by mailor email (info@bccsw.ca); degrees are not listed on transcripts until after convocation.

i. Applicants must still arrange for an official transcript to be mailed directly to the College after theirdegree has been conferred by the awarding institution.

b. Applicants educated outside Canada and the USA must arrange to have a basic report from theInternational Credential Evaluation Service (ICES) sent directly to the BCCSW. Find their information atwww.bcit.ca/ices

c. Applicants who do not have a social work degree should refer to the College’s requirements forindividuals without a social work degree here.

7. Reference Forms: Two (2) letters of reference on the forms provided sent directly to the College by the referees(refer to the website for correct form).

a. Referees must have known the applicant for over one year and not be a relative.b. Reference forms can be sent to the College through email, fax, or mail.

8. Verification of Registration/Licensure form: Applicants, who are currently or have been in the past registeredwith another regulatory body, are required to have this form submitted by each regulatory body. There areseparate forms for social work regulators and non-social work regulators, which can be found on the'Application Forms' page of our website. Please ensure that you are using the appropriate form. This form mustbe mailed back to the College from the other body.