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BCRSP Application Page 1 of 12
Application for Canadian Registered Safety Professional CRSP® Designation
PLEASE READ THE ENTIRE APPLICATION FORM BEFORE YOU BEGIN COMPLETING EACH SECTION
PLEASE COMPLETE AND SUBMIT ORIGINAL AND ONE COPY OF APPLICATION FORMAND ONE COPY ONLY OF SUPPORTING DOCUMENTATION ALONG WITH THE NON-REFUNDABLE
APPLICATION FEE TO:
Board of Canadian Registered Safety Professionals6700 Century Ave Suite 100Mississauga, ON L5N 6A4
FEES: R#100304195
Non-Refundable Application Fee $525.00 + HST/GSTResidents of AB, BC, SK, MB, QC, YT, NT, NU – Add 5% GST ($525.00 + $26.25 = $551.25)Residents of ON, NB, NL – Add 13% HST ($525.00 + $68.25 = $593.25)Residents of PEI – Add 14% HST ($525.00 + $73.50 = $598.50)Residents of NS – Add 15% HST ($525.00 + $78.75 = $603.75)Residents outside of Canada - $525.00
Application Fee Credit Card Payment:
Name of Applicant: Province of Residence:
Payment By: American Express MasterCard Visa
Card # Cardholder’s Name:
Expiry Date:
CVV#:
I authorize a $525.00 + HST/GST charge to the credit card noted above.
Signature:
Payment By: Cheque enclosed made payable to the BCRSPPayment Online: If you submitted your payment via the BCRSP website, please enclose a copy of the receipt delivered to you via email.
Applications submitted electronically or via facsimile or handwritten submissions will not be accepted.Please do not cerlox-bind your submission.
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BCRSP Application Requirements
Before submitting your application, please ensure that all sections of the application (Parts A, B, C and Factors 1, 2, and 3) are completed in full and the “Declaration” is signed and dated. Supporting documentation must be clearly identified by Factor and attached in the same order as listed on the application.
Applications that are not fully completed with documentation attached and in the proper order will be returned to the applicant for resubmission. A $50.00 (+ HST/GST) resubmission fee must accompany the resubmitted application.
Chronological resumes should be submitted with your application however, they are not considered official documents but may be used by the Qualifications Review Committee to clarify formal education and employment information and dates.
International Applicants
International applicants whose first language is neither English nor French must:
Submit documentation verifying a minimum score of 94-101 on a Test of English as a Foreign Language (TOEFL ®) IBT; a band score of 7 on the International English Language Testing Sytem or a score of 785-900 on a Test de français international (TFI ™ ) . (Equivalent proof of language proficiency (e.g. a university assessment) will also be accepted)
Foreign credentials must be translated to English or French and be verified by an official translator Foreign credentials must be submitted to a Canadian Credentialing Agency (see below) prior to
application submission.
Foreign Credential Assessment and Evaluation
Alliance of Credential Evaluation Services of Canada (Pan-Canadian) www.canalliance.org/indexe.stm Canadian Association of prior Learning Assessment (Pan-Canadian) www.capla.ca/news.php Canadian Information Centre for International Credentials (Pan-Canadian) www.cicic.ca University of Toronto – Comparative Education Service (Pan-Canadian) www.adm.utoronto.ca/ces International Qualifications Assessment Services (AB, SK, NT)
www.employment.alberta.ca/cps/rde/xchg/hre/hs.xsl/4512.html British Columbia Institute of Technology - International Credential Evaluation Services (BC)
www.bcit.ca/ices Academic Credentials Assessment Service (MB)
www2.immigratemanitoba.com/browse/work_in_manitoba/work-recognition-acas.html World Education Services (ON with pan-Canadian applicability) www.wes.org/ca/employers/index.asp Centre d’expertise sur les formations acquises hors du Québec (QC) www.immigration-
quebec.gouv.qc.ca/en/education/comparative-evaluation/index.html
Reference : The Employer’s Roadmap, Hiring and Retaining Internationally Trained WorkersCitizenship and Immigration CanadaForeign Credentials Referral OfficeC&I-1019-05-09Ewww.credentials.gc.ca
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APPLICATION FOR CERTIFICATION
It is the responsibility of applicants to review the “BCRSP Application & Eligibility Requirements” document before completing the application form. International applicants are reminded to review the
requirements for application submission.
Please note:If you have submitted your certification application, you may advise prospective employers that you have made application to the Board of Canadian Registered Safety Professionals. You may NOT indicate that you are a CRSP, a candidate CRSP, an applicant CRSP, a CRSP in process or a pending CRSP. The designation may not be used until such time as you have successfully completed the certification process, been awarded the designation by the Governing Board and received verification of certification (certificate and ID card). Unauthorized use of the CRSP prior to Governing Board approval and receipt of proof of certification may result in a the application process being terminated.
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Part A: Personal Information
Salutation Mr (Please select via drop down list)
Last Name
First Name
Employer
(Current employer information
must be completed)
Your Position/Title
Business Address
City
Province
Postal Code
Business Telephone ( )
Home Address
City
Province
Postal Code
Home Telephone ( )
Preferred Mailing Address Business Home
It is the applicant’s responsibility to keep the BCRSP informed of any changes to the above
information.
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Part B: Reference Questionnaire (RQ)
Please provide the name, title, employer, telephone number and email address of your reference. When selecting your reference, be sure this individual has knowledge of the OHS work you have done and the degree of responsibility you have in the administering of your employer’s OHS program. You may not use anyone as a reference over whom you have supervisory responsibilities. It is not necessary that your reference be a Canadian Registered Safety Professional (CRSP)®.
The completed Reference Questionnaire is NOT to be returned to the applicant, but sent directly to the Board. A Reference Questionnaire included with an application will not be considered and a new reference will be requested.
Contact Information for the Individual Completing the Reference
Name
Title
Employer
Telephone (with area code)
Part C: Practice Questionnaire (PQ)
Please provide the name, title, employer, telephone number and email address of your immediate supervisor. If you are a private consultant, the Practice Questionnaire may be completed by a current client.
The completed Practice Questionnaire is NOT to be returned to the applicant, but sent directly to the Board. A Practice Questionnaire included with an application will not be considered and a new Practice Questionnaire will be requested.
Immediate Supervisor/Client Completing the Questionnaire
Employer Client
Name
Title
Employer (only if client)
Telephone
The same individual may not complete both the Reference Questionnaire and the Practice Questionnaire on behalf of the applicant.
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Factor 1 : Formal Education
Minimum points required = 50; maximum points available = 100 Minimum requirement: a one year college/university certificate/diploma in OHS OR a two year college/university non OHS certificate/diploma.
Formal Education Value
OHS
**One year OHS college or university certificate or diploma 50
Two year OHS college or university certificate or diploma or one year post diploma 70
Three year OHS college or university certificate, diploma or degree 80
Four year OHS college or university diploma or degree 100
Post graduate OHS degree 100
NON-OHS
**Two year non-OHS college or university certificate or diploma 50
Three year non-OHS college or university certificate, diploma, degree or one year non-OHS post diploma 60
Four year non-OHS college or university diploma or degree 70
Post graduate non-OHS college or university degree 80
Applicants who completed formal education above the minimum requirement (e.g. undergraduate degree or college diploma in any discipline) meet the formal education requirements for certification. All completed post-secondary education programs may be claimed to a maximum of 100 points as follows:
The highest level of completed formal education will be awarded the maximum number of points as per the matrix below
Each additional level of completed formal education will be awarded 50% of its point total Specialty certificates/diplomas/degrees within the scope of OHS practice should be claimed as non OHS programs
(i.e. kinesiology, ergonomics, environment, etc). OHS programs must be generalist in content reflecting the CRSP generalist designation as outlined in the Examination Blueprint.
Program length is based on full-time attendance. If you are enrolled as a part-time student and it takes two to three years to complete what is a one year program for a full-time student, you must claim it as a one-year program.
To receive Factor 1 credit, applicants must request granting institution to provide a final sealed transcript. Transcripts that have been photocopied or scanned will NOT be accepted.
Level Completed College/University Program Name Year Graduated/ Completed
QRC Use Only
One year OHS college or university certificate or diploma
Two year non- OHS college or university certificate or diploma
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Factor 1 : Formal Education
Minimum points required = 50; maximum points available = 100 Minimum requirement: a one year college/university certificate/diploma in OHS OR a two year college/university non OHS certificate/diploma.
Two year OHS college or university certificate or diploma or one year post diploma
Three year non- OHS college or university certificate, diploma, degree or one year non-oh&s post diploma
Three year OHS college or university certificate, diploma or degree
Four year non- OHS college or university diploma or degree
Four year OHS college or university diploma or degree
Post graduate OHS degree
Post graduate non- OHS college or university degree
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Factor 2 : Professional Development
Minimum points required = 15; maximum points available = 100 List all OHS-related training courses/seminars/conferences you have completed beginning with the most recent. To obtain credit, you must attach a copy of the course/seminar/conference outline that shows the title of course, length of course, name of course provider, and a copy of any certificate received or furnish equivalent proof of completion such as a letter from the organization presenting the course/seminar/conference.
Professional development credits will not be granted without documentation. Documentation must be attached for each course/seminar/conference in the same order as listed on the application. If you do not have supporting documentation, do not list the professional development activity on your application.
In-house training will be considered, however, applicants must provide verification from their employer of course dates, content and successful completion. Orientation training to meet job requirements may not be claimed in Factor 2.
IMPORTANT: The time limit for Category A1 and A2 professional development activities is five (5) years or 60 months. (The 5 years (60 months) is calculated from the date the application is received by BCRSP.)
There is no time limit for Category B OHS credit courses. Individual courses from completed OHS certificates cannot be claimed under Factor 2.
Online Courses:Points may be awarded based on technical contact time as identified by the course provider, not the actual contact time for the applicant completing the activity. If the course provider cannot provide contact time for the activity, no points will be awarded.
Activity Value
A1. OHS courses/seminars/conferences of a minimum one day (6 hours) duration
1 point/day
A2. Non OHS course/seminars/conferences of a minimum of one day (6 hours) duration
1 point/day (to a maximum of 5 points)
B. College/university OHS credit course (not part of formal education – Factor 1)
10 points/course
A1. OHS courses/seminars/conferences, minimum of one day (6 hours duration) completed in the last five years (60 months).(from the date of application received)
Course Provider Title of Course / Seminar / Conference
Total Hours
Start/Finish Dates QRC Use Only
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Factor 2 : Professional Development
Minimum points required = 15; maximum points available = 100 List all OHS-related training courses/seminars/conferences you have completed beginning with the most recent. To obtain credit, you must attach a copy of the course/seminar/conference outline that shows the title of course, length of course, name of course provider, and a copy of any certificate received or furnish equivalent proof of completion such as a letter from the organization presenting the course/seminar/conference.
Professional development credits will not be granted without documentation. Documentation must be attached for each course/seminar/conference in the same order as listed on the application. If you do not have supporting documentation, do not list the professional development activity on your application.
In-house training will be considered, however, applicants must provide verification from their employer of course dates, content and successful completion. Orientation training to meet job requirements may not be claimed in Factor 2.
IMPORTANT: The time limit for Category A1 and A2 professional development activities is five (5) years or 60 months. (The 5 years (60 months) is calculated from the date the application is received by BCRSP.)
There is no time limit for Category B OHS credit courses. Individual courses from completed OHS certificates cannot be claimed under Factor 2.
Online Courses:Points may be awarded based on technical contact time as identified by the course provider, not the actual contact time for the applicant completing the activity. If the course provider cannot provide contact time for the activity, no points will be awarded.
A2. Non OHS courses/seminars/conferences, minimum of one day (6 hours duration)., to a maximum of 5 points completed in the last five years.
Course Provider Title of Course / Seminar / Conference
Total Hours
Start/Finish Dates
B. College or university credit courses having a minimum duration of one full semester (35 hours). College/university original transcript must be received in order to receive credit. Do not include courses completed for formal education programs claimed in Factor 1.
College/University Course Total Hours
Start/Finish Dates
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Factor 3: Professional Practice (Related Experience)
Minimum points required = 50; maximum points available = 100 Credit will be given for each year of continuous OHS employment to a maximum of eighty-five months (seven years). The minimum requirement for registration is thirty-six months (three years).
NOTE: University/college/co-op work terms may not be applied to professional practice.
The Qualifications Review Committee evaluates each job position using the criteria listed on the Professional Practice Experience Form to determine whether it is accepted as professional practice. Failure on any one means that the position is not accepted.
You must complete a Professional Practice Experience Form for each position listed below for which you are seeking credit. Do not overlap time periods.
Note: Gaps in employment due to parental leave, LTD, returning to school full-time, unemployment, etc, to a maximum of 12 months will not negate the 36-month continuous employment requirement but must be identified on the application. Employment gaps of more than 12 months will be assessed on a case-by-case basis.
Full-time OHS related experience Value
Minimum 36 months (3 years) 50
37-60 months (3 years - 5 years) 65
61-84 months (5 years - 7 years) 80
85+ months (7+ years) 100
Current Resume is Enclosed with Application
Employer Job Title Dates Employed (Month/Year to Month/Year)Do not overlap months
Professional Practice Experience Form Enclosed
Job Description enclosed
Employer verification letter enclosed
QRC Use Only
Current Employer
1st previous employer
2nd previous employer
3rd
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previous employer
DECLARATION
I certify that the information contained in this application and all documents attached thereto, are factual and accurate to the best of my knowledge and hereby request assessment by the Qualifications Review Committee. If approved to proceed with the certification process, I agree to present myself at a Regional Screening Centre of my choice for interview. If approved to write the certification examination (CRSPEX), I understand that the examination is a computer based test (CBT) based on the Examination Blueprint and administered at third party test centres contracted by the Board. I agree to abide by the Board’s Code of Ethics and understand that the Governing Board shall be the sole authority as to who shall and who shall not be approved for certification.
Signature:
Date:
Application Assessment
The final determination of the acceptability of an applicant to proceed to a Regional Screening Centre interview is made by the Qualifications Review Committee. Applicants should not assume that their assessment of points awarded in Factors 1, 2 and 3 will be the same as that of the Qualifications Review Committee.
A minimum total of 150 points from all three Factors is required for a applicants to proceed in the certification process. Applicants must obtain a minimum of 50 points in Factor 1 (Formal Education), 15 points in Factor 2 (Professional Development), and 50 points in Factor 3 (Professional Practice).
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QUESTIONNAIRE (Optional)
Your response to the following would be appreciated
How did you hear about the CRSP designation?
Colleague Employer requirement Job advertisement Trade show exhibit (please specify which trade show): OH&S Conference Presentation (please specify which conference): Magazine advertisement (please specify which publication): Website Educational institution Other (please specify):
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