Provisional Registration Application

NOTE: If previously registered or licensed with CRNNL do not complete this application. Contact CRNNL regarding the process to renew your license/membership.

(A) Personal Information
  1. Are you:




  2. Please provide your name as it appears on your government issued identification:

  3. MM/DD/YYYY
  4. Please provide your permanent address:

    Note: If you cannot find your City/Province/Country name in the drop down menu please select 'Other' and you will be able to type in the information.

  5. US / Canada: (###) ###-####
  6. Gender:            


  7. Enter the language that you learned first as a child and is the language that you use primarily for reading, writing listening and speaking. For more information, click here to view the English Language Proficiency fact sheet.


(B) Legal Documents

You must submit the following documents to the CRNNL . You may be required to resubmit a document(s) if it is of poor quality.

  1. Government issued identification (which includes your photo and signature). Examples: Passport or Drivers License
  2. Copy of your Birth Certificate

If your current name does not match exactly that shown on your Birth Certificate:

  1. Copy of your Marriage Certificate OR Legal Change of Name document

Otherwise:


UPLOAD DOCUMENTS

You may submit digital copies of these documents using the form below. Only the following types of files will be accepted: PDF, JPG, GIF, TIF.

  1. Government issued identification (which includes your photo and signature). Examples: Passport or Drivers License:
    You can upload your file by dragging it here.
  2. Birth Certificate:
    You can upload your file by dragging it here.
  3. Marriage Certificate OR Legal Change of Name document:
    You can upload your file by dragging it here.


(C) Nursing Information
  1. Nursing Education:

    Please Note: click here to find your Education Program Code.
    MM/DD/YYYY
    MM/DD/YYYY
    MM/DD/YYYY

  2. For confirmation of successful program completion, applicants must submit the following directly to CRNNL :
    • Official transcript from University/School of Nursing
  3. Professional Reference:

    Please note: CRNNL will not confirm your exam eligibility until a satisfactory Newfoundland and Labrador professional reference has been received.



(D) Other Registrations

Not applicable. Only required for Canadian RN's or Internationally Educated Nurses.

Please specify the jurisdiction(s) (province/state/country) where you are currently registered or were previously registered or licensed to practice as a Registered Nurse.

Please specify the jurisdiction(s) (province/state/country) where you are currently registered or licensed to practice as a Registered Nurse.


Note: If you cannot find your Jurisdiction name in the drop down menu please select 'Other' and you will be able to type in the information.




(E) Exam Information

Not applicable. Only required for Newfoundland and Labrador New Graduate, Canadian New Graduate and Internationally Educated Nurse applications.

  1. Have you previously written:

    Canadian Registered Nurse Examination?            

    MM/DD/YYYY Did you pass this exam:            

    NOTE: Verification of successful examination completion must be provided to CRNNL directly from the Regulatory Body/Board of Nursing. You must contact the Regulatory Body/Board of Nursing to request this information.


    NCLEX-RN?            

    MM/DD/YYYY Did you pass this exam:            

    NOTE: Verification of successful examination completion must be provided to CRNNL directly from the Regulatory Body/Board of Nursing. You must contact the Regulatory Body/Board of Nursing to request this information.

  2. If requesting exam eligibility from CRNNL , are you requesting Testing Accommodations?

                           

    * NOTE: You must contact the CRNNL to request Testing Accommodations prior to the examination.



(F) Registered Nursing Experience

Not applicable. Only required for Canadian New Graduate, Canadian RN or Internationally Educated Nurse applications.

IMPORTANT: Canadian New Graduates must submit a professional reference letter from a nursing faculty member, clinical supervisor or RN preceptor. Must be in letter format and sent directly to CRNNL .

  1. If you have no work experience, please check this box.

  2. Please provide the following information for all nursing employers within the last five (5) years, starting with the most recent. List your employment as a Registered Nurse:




    MM/DD/YYYY
    MM/DD/YYYY




(G) Certificate of Conduct

All applicants are required to submit a current Certificate of Conduct directly to CRNNL . For more information on accepted sources and the submission process, please refer to the CRNNL Fact Sheet on Certificate of Conduct. For new graduates, refer to Registered Nurse Examination page on the CRNNL website for submission deadline dates.



(H) Questions

The information provided on this application and the answers to the following questions are required in accordance with the Registered Nurse Regulations for a who are applying for registration with the CRNNL .

  1. Have you been convicted of an offence under the Criminal Code (Canada), the Controlled Drugs and Substance Act (Canada) or a similar penal statue in another jurisdiction (province/territory/country) for which you have not received a pardon?

               
  2. Do you have any physical or mental conditions or disorder that may or does currently impair your ability to practice nursing safely and competently?
    Please refer to and review the CRNNL Document Requisite Skills and Abilities as you reflect on and answer this question.

               
  3. Have you been denied registration in another jurisdiction (province/territory/country) within the last five (5) years?

               
  4. Is your registration/License to practice nursing under review/investigation, suspended or revoked; or are there any disciplinary procedures commenced, in process or pending, in another jurisdiction (province, territory or country?

               
  5. Have you completed a CBA (Competency Based Assessment) or SEC (Substantially Equivalent Competency) assessment?

               
  6. Do you consent to the CRNNL to release your results of the Nursing Registration Exam to the Director/Associate Director of the Nursing Education Program from which you graduated?

               

IMPORTANT: As you have indicated 'Yes' on one or more questions above, you must forward details to the CRNNL (registration@crnnl.ca). Your application will not be reviewed until an explanation is received.





Contact CRNNL