Fillable MEMBER APPLICATION CON V3.5.0 EN MS MR 12 04 2019 FILLABLE

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MEMBER APPLICATION CON V3.5.0 EN MS MR 12 04 2019 FILLABLE

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Page 1 of 3
MEMBER APPLICATION
1.
Information for All Applicants
Are you already a member of the Ontario College of Trades?
Yes
No
If Yes, what is your membership number?
First Name Middle Name or Initial Last Name
Former Name (if any)
Preferred Language
Gender
Female
English French
Primary Phone Number
Email Address
Home Address (if more than one please enter your principal residence)
Street Number Street Name
Secondary Phone Number
Unit Number
PO Box
City / Town
Province
Postal Code
Country
Street Number
Business telephone number (self employed)
Unit Number
PO Box
Country
Postal Code
Province
City / Town
Are you self-employed?
Yes No
If No, what is the name of your current employer?
Have you ever been issued a Certificate of Apprenticeship, Letter of Permission, Provisional Certificate of Qualification or Certificate of Qualification in Ontario?
Yes
No
Certificate Number
Date of Issue (mm/dd/yyyy)
Full name as it appears on certificate
If Yes, please detail below. Continue on a separate sheet if necessary.
Certificate Number
Date of Issue (mm/dd/yyyy)
Full name as it appears on certificate
2. Trade Information
Trade(s) Name(s) under which you are applying for membership
Tr
ade(s) Code(s) under which you are applying for membership
The information provided in or in connection with this application is collected, used and disclosed under the authority of the Ontario College of Trades and
Apprenticeship Act, 2009 (OCTAA), the Regulations under the OCTAA, the College’s by-laws, and other applicable laws or regulations.
Date of Birth (mm/dd/yyyy)
Street Name
Business Address (self employed)
I am attaching a cheque or money order to cover fees or,
I authorize the use of the following credit card to cover fees as follows: Credit Card Payment Type: Visa 
Mastercard
American Express
Credit Card Number:
Expiry Date:
BBBBBBBBBBBB
(mm/yyyy)
Print Cardholder's Last Name:
First Name:
Signature of Cardholder: Date signed: _______ / _______ / _______
(mm/dd/yyyy)
3.
Payment Processing (Note: All payments to be made payable to the Ontario College of Trades)
Ontario College of Trades
655 Bay Street Suite 600
Toronto, Ontario M5G 2K4
Telephone: 416-673-6524 ,
Toll free: 1-855-299-0028, Fax: 1-647-348-5002
E-mail: membership@collegeoftrades.ca
HST NO: 839542511RT
Section A - Member Identification
Type of payment:
Journeyperson MHPEHUVKLSIHH: $67.80 ($60.00 + HST)
$SSUHQWLFHVKLS0HPEHUVKLSIHH: $0
Apprentices
Journeypersons Candidates
Tradespersons
Journeypersons
Apprentices (OYAP)
As an Ontario College of Trades (the College) member, you have the right to have your statements, receipts and communications provided or made available to you through one
of the following methods: electronically through email or paper via postal delivery. By default the College will communicate all statements, receipts and communications
electronically when an email address is provided. At any time you may change the delivery method of your statements, receipts and communications by logging into your member
account through our online portal or by contacting our Client Service Department at 1-855-299-0028.
By checking this box, I hereby request that the Ontario College of Trades send my statements and receipts by postal mail rather than email.
Ontario College of Trades Copyright 2013, Last Revised 12/04/2019
ME
MBER_APPLICATION_CON_V3.5.0_EN_MS-MR_12-04-2019
FOR YOUR PROTECTION:
Please do not EMAIL credit card information. For Credit Card payments call or fax to the numbers at the top of this form.
Male
Other
Prefer not to Disclose
Transgender
Membership Class:
Please Note: For payments other than initial membership fees please contact our Client Service Department at 416-673-6524 or 1-855-299-0028 for payment
information and options.
As a note to all applicants, please be reminded that the College takes reasonable steps to verify information provided in support of any application. Applicants are responsible
for ensuring the accuracy and validity of all information provided. During the assessment of an application, or at any later date, if the College determines that false, misleading
or incorrect information was provided, an application may be cancelled, revoked and/or refused. Additionally, if it is found that anyone attesting to an applicant’s trade
qualifications and/or experience has provided false or misleading statements of any kind, further consequences under the Ontario College of Trades and Apprenticeship Act,
2009, with fines of up to $10,000 may apply.
Tradesperson0HPEHUVKLSIHH: $0
NOTE: Apprentice in Ontario Youth Apprenticeship Program (OYAP) Applicants are Fee Exempt ($0)
✔
First Name Middle Name or Initial Last Name
Preferred First Name Former Name (if any)
Relationship to Applicant Does the Applicant live with you?
Email Address
Home Address (if more than one please enter your principal residence)
Home Phone Number
Cell Number
Street Number Street Name U
nit Number
PO Box
City / Town Province Postal Code Country
Business Address Business telephone number
Street Number Street Name Unit Number
PO Box
City / Town Province Postal Code Country
and confirm that the information contained
,
I declare that I am the custodial parent or guardian of
I have read the application completed by
therein is accurate and consent to the application being filed.
Signature of Parent / Guardian
X
Date (mm/dd/yyyy)
/ /
Your response to this question is entirely voluntary and will not affect your eligibility for membership.
The information will be used by the College for policy analysis and statistical purposes related to employment
programs and services.
First Nations
Métis
Inuit
Persons with Disabilities
Visible Minority
Newcomer to Canada; if yes, how long? Months____________ Years_____________
Page 2 of 3
YES NO
Additional Information
If you, the Applicant, are not able to have a parent or guardian sign this Consent for Minors, please explain why.
Declaration of Accuracy and Consents for Application by Parent or Guardian
SECTION B - CONSENT FOR MINORS (Appl
icant is less than 18 Years of Age)
1
.
Pa
rent
or
G
uardian Information
SECTION C - VOLUNTARY SELF DECLARATION (STATISTICS COLLECTION)
Do you wish to self-identify as a member of a designated group?
Ontar
io College of Trades Copyright 2013, Last Revised 12/04/2019
MEMBER_APPLICATION_CON_V3.5.0_EN_MS-MR_12-04-2019
Page 3 of 3
Declarations of Accuracy and Consents for Application
Date (mm/dd/yyyy)
X
I consent that all information, documents or records requested by the College for the above-noted purposes from other sources may be provided to the College.
In addition, I consent that the College may collect, use and disclose my personal information and confidential information provided in or in connection with this application as
provided above, as well as in accordance with the College’s privacy policy available at http://www.collegeoftrades.ca/privacy and as permitted or required by applicable laws or
regulations.
The information provided in or in connection with this application is collected, used and disclosed under the authority of OCTAA, the Regulations under the OCTAA, the College’s
by-laws, and other applicable laws or regulations.
I consent that the College may collect, use and disclose any information provided in or in connection with this application for the following purposes:
• verifying the information;
• processing this application;
• administering my file or membership with the College;
• administering and enforcing the OCTAA, the Regulations under the OCTAA, and the College’s by-laws;
• conducting inspections or investigations;
• conducting policy analysis, evaluation and research related to apprenticeship and trades certification;
• any other purpose for which the College requests your consent and to which you consent;
• as required or permitted by law
SECTION D - Declarations and Consent
No Yes If Yes, provide details.
No Yes If Yes, provide details.
No Yes If Yes, provide details.
No Yes
If Yes, provide details.
Certification of Accuracy of Information Provided
I declare that by signing below, all information I have provided or will provide to the Onta
rio College of Trades (the “College”)
in
the
future
in
or
in
conne
ct
ion
with
thi
s
application
is true,
accurate
and
complete. I agree
to immediately notify
the College regarding any future changes to information I have provided.
I acknowledge that if I provide false or misleading information or documents to the College, or fail to provide information or documents requested by the
College:
• I ma
y be denied a Certificate of Qualification, Provisional Certification of Qualification, or a Statement of Membership;
any Certificate of Qualification, Provisional Certificate of Qualification, or a Statement of Membership issued by the College to me may be suspended, revoked, or made
subject to specified terms, conditions or limitations;
I may be guilty of an offense and on conviction liable for a fine; or
I may be subject to other proceedings, penalties, costs, or consequences under the Ontario College of Trades and Apprenticeship Act, 2009 (the “OCTAA”), the Regulations
under the OCTAA, and the College’s by-laws, including but not limited to, professional misconduct proceedings which could result, if I am found guilty, in a range of
penalties, including an order directing the Registrar to revoke, suspend or impose terms, conditions or limitations on any Certificate of Qualification, Provisional
Certificate of Qualification, or Statement of Membership which the College may issue to me
.
• my current and former employers;
• government
a
l
b
o
d
i
es
,
o
rg
a
n
i
z
atio
n
s
(
including departments, boards and agencies) or officials, police forces or military autho
rities;
•
governing, regulatory, self-regulatory, apprenticeship or trades bodies, authorities, agencies or officials;
• educational inst
itutions;
• consumer
reporting agencies;
• publicly available sources under applicable laws or regulations;
• any
other
relevant sources.
For staff use only- do not write in this section
Entered into TMS
Staff name:
Staff signature:
Date:
(mm/dd/yyyy)
Consent
I consent that the College may for the purposes of the administration of the OCTAA contact, request information, documents or records from, and provide information to, other
sources including:
Background Questions
•
•
•
In the following questions, “you” refers both to an individual and to any corporation, partnership, proprietorship, or other organization used by an individual
(alone or with others).
If you answer “Yes” to any of the following questions, please provide full details, including particulars, dates, results, outcomes, and supporting documents
(if you need more space, please attach an extra page).
Have you ever had investigations proceedings or actions commenced against you by an apprenticeship or trades organization, regulatory or self-regulatory
body in Canada or elsewhere, in relation to discipline, misconduct, incompetence, or incapacity?
Have you ever been refused membership, a licence, or a permit from an apprenticeship or trades organization, regulatory or self-regulatory body in Canada
or elsewhere, on the grounds of discipline, misconduct, incompetence, or incapacity?
Have you ever had your membership, licence, permit or training agreement issued by an apprenticeship or trades organization, regulatory or self-regulatory
body in Canada or elsewhere, revoked, suspended, or made subject to specified terms, conditions or limitations on the grounds of discipline, misconduct,
incompetence, or incapacity?
Have you ever, as a member or holder of a licence, permit or training agreement of an apprenticeship or trades organization, regulatory or self-regulatory
body in Canada or elsewhere, been reprimanded, admonished, fined, found guilty of an offence, received counselling, required to perform training or
course of study, subject to any other remedial measures, or resigned, on the grounds of discipline, misconduct, incompetence, or incapacity?
Signature
Ontario College of Trades Copyright 2013, Last Revised 12/04/2019
MEMBER_APPLICATION_CON_V3.5.0_EN_MS-MR_12-04-2019
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MEMBER APPLICATION CON V3.5.0 EN MS MR 12 04 2019 FILLABLE

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Completed 18 July 2020

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