Practicing to SJLPN Online Renewal Form

Practicing to SJLPN Online Renewal Form
Name
Name
First
Last
Address
Address
City
State/Province
Zip/Postal
Country

Employment

Choose one or more of the following:

Other LPN Jurisdictions

Please check off all Canadian jurisdictions where you are currently registered to practice as an LPN:

Declarations

Have you been charged with or convicted of a criminal offence: since you were last licensed with the CLPNS, or within the last 12 months?
As an LPN, you must report any condition that significantly impairs or could impair your professional practice. This includes physical, mental, or emotional conditions, and substance use disorders. Examples of reportable conditions include:

  • Severe depression
  • Uncontrolled anxiety
  • Substance addiction
  • Neurological disorder

Conditions that are temporary, well-managed, or do not affect safe nursing care (e.g., recent sprains, mild anxiety managed through therapy or control chronic conditions) do not require reporting.

The Standards of Practice mandate reporting any medical condition that could hinder competent nursing duties. This transparency maintains professional integrity and ensures patient safety.

Do you currently have any health conditions that may impact your ability to provide safe and effective patient care?
I am currently under investigation or have a complaint filed against my practice in a jurisdiction outside of Saskatchewan.

Licensure Declaration

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 in the CLPNS office 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.

Consent to Revocation/Suspension

I acknowledge and agree that the CLPNS may immediately revoke, suspend or refuse licensure if any information contained in this form is inaccurate or incomplete.

Privacy Statement

I acknowledge and agree that the CLPNS may immediately revoke, suspend or refuse licensure if any information contained in this form is inaccurate or incomplete.

Release of Information

The CLPNS is obligated to report membership statistics annually to the Canadian Institute of Health Information (CIHI). I understand aspects of my form will be de-identified and provided to CIHI for statistical purposes only.

Culturally Safe Care

I understand that LPNs are expected to provide care that is physically, psychologically, and culturally safe. I will promote inclusion, belonging, and environments that are free from racism and discrimination.

SJLPN Continuing Competence

As a Secondary Jurisdiction LPN in Saskatchewan, I confirm that I meet the currency of practice requirements in my primary jurisdiction of licensure, for example: continuing competence, practice hours. I understand that the CLPNS may require proof that I’ve met the currency of practice requirements in my primary jurisdiction of licensure.

Primary Jurisdiction Outside of Saskatchewan

I confirm that, as a Secondary Jurisdiction LPN in Saskatchewan, my primary registration and licensure remains in a Canadian jurisdiction outside of Saskatchewan.

Payment

Once your submitted form is reviewed, an invoice for the SJLPN licensure fee ($200) will be added to your record and available for payment on your portal.