Degree Nurse Application Form

Degree Nurse Application

This application is for the following applicants:

  1. SK PN grads who passed the CPNRE, but did not take out Graduate LPN licensure or,
  2. Applicants who completed a Canadian degree or BsCN nursing program and want to become an LPN.

This form is NOT for LPNs licensed in other Canadian jurisdictions or for Internationally Educated Nurses (IENs).

Address
Address
City
Province
Postal Code
Country

Nursing Education
(Provide all nursing programs taken, including both basic and re-entry programs).

If you have more than one program to enter, please provide all the above details for the other programs below.

Current/Past Nursing Registration/Licensure
(Provide all places of registration, other than with CLPNS, or other regulated profession(s). i.e. Registered Nurse, Physiotherapist, midwife, paramedic, etc.)

If you're not currently registered, then provide the most recent place of registration/licensure. If more than two, please provide.

If you have more than one registration/profession or recent places of registration/licensure, provide all the above details below.

Declarations

The Standards of Practice for Licensed Practical Nurses in Canada states that LPNs "Have the duty to report any circumstance that potentially and/or actually impede professional, ethical, or legal practice." Have you ever been subject to any investigative proceedings with respect to unprofessional conduct, incompetence, or incapacity in nursing by any regulatory body, in Saskatchewan or any other province, territory, state or country (excluding CLPNS)?
I declare that all of the information on this form is current, correct and complete.
I hereby certify that I am the person making application for licensure as a Licensed Practical Nurse in Saskatchewan and that all statements are true and complete in every respect.
I understand that omission, inaccuracy, and falsification of information on this application may result in the cancellation of my application for licensure or cancellation of any licensure, which may be issued.
I understand that my application for assessment of eligibility and/or licensure is considered lapsed if required documentation is not received by the CLPNS and I have not obtained licensure within 6 months from my application date. I understand that after 6 months have lapsed I am required to reapply.
Have you been charged with or convicted of a criminal offense? If yes, please explain. A copy of an updated Criminal Record Check will be required to be sent to CLPNS.
Is English language your first learned language and is it the language you first learned and understood in childhood for reading, writing, listening, and speaking.
If no, one of the following will be accepted:
I understand I am required to send CLPNS a copy of photo identification and updated Criminal Record Check when requested.
Privacy Statement
Consent to Revocation/Suspension of Licensure
Licensure Declaration
Once you submit the form, the CLPNS will contact you with the next steps of the application process. Please allow up to ten (10) business days for the CLPNS to respond.