Criminal Record Assessment: Pre-Licensure

Criminal Record Assessment

This form is for individuals who have a criminal conviction(s) on their record and are seeking a review by the CLPN to determine registration and licensure eligibility.

Who should complete this application?

1. Students enrolled in a Practical Nursing Program with an “unsatisfactory” criminal record and want their eligibility for registration and licensure with the CLPNS determined before program completion.

2. LPNs registered and licensed in another jurisdiction with an “unsatisfactory” criminal record and want their eligibility for registration and licensure with the CLPNS determined before they formally apply.

Please review the CLPNS's Criminal Record Check Assessment Policy and complete the following form.

Address *
Address
City
State/Province
Zip/Postal

Maximum file size: 268.44MB

There is a $100 fee to have your criminal record assessed. Once you submit your assessment, an invoice is generated to your CLPNS Member Portal. To access the portal you will need to set up a CLPNs account.