Work History Form for LMS uploads (21 April 2021)
Work History Form
Applicant:
Name (First, Middle, Last) Designation & Member #
Certification - Applicant
I recognize that under the
Professional Governance Act
, a person commits an offence if they apply for membership by false or fraudulent
representation. I certify that the information provided in this form and in any documents attached is correct, complete and provides full
disclosure. I also certify that the foregoing is a true record of my work experience.
Date (mm/dd/yy) Signature of Applicant
Certification - Sponsor
I recognize that under the
Professional Governance Act
, a person commits an offence if they knowingly assist another person to apply for
membership by false or fraudulent representation. I therefore certify that the information provided in this form is true to the best of my
knowledge and belief. I also certify that I consider the applicant suitable for registration.
(Important: You must directly contact the registrar at admissions@abcfp.ca if you have any reservations about the suitability of the applicant
for registration.)
Sponsor Name (Print) Sponsor Member #
Date (mm/dd/yy) Signature of Sponsor
Both signatures are required at the time of upload.
• Electronic signatures are acceptable (i.e. an image of your signature), not fonts.
• To add your electronic signature, click "fill and sign" (right-hand side), then click:
• Need
help: https://www.howtogeek.com/164668/how-to-electronically-sign-documents-
without-printing-and-scanning-them/
• Electronic signature not working? Print, sign, scan, and save. Then upload.