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Legal and regulatory disclosure requirements

Each application, as part of the registration process, must complete the following disclosure form. Additionally, each CPCA must update this disclosure form annually and re-commit annually to abide by the Code of Professional Responsibility. The form below is for illustration purposes only.

 

* Disclosure Questionaire

1. Have you been accused or convicted of a criminal offence?

Yes
No

2. Are you currently or have you within the past five years been a defendant or respondent in any criminal proceeding relating to your professional or business conduct?

Yes
No

3. Are you now or have you within the past five years been a defendant or respondent in a civil action, which includes but is not limited to a lawsuit, arbitration, or mediation relating to your professional or business conduct?

Yes
No

4. Have you had a license, permit, certificate, registration, or membership denied, suspended, revoked, or restricted within the past five years, or have you had an application withdrawn for cause within the past five years?

Yes
No

5. Have you ever been censured, fined, or reprimanded by a province or federal licensing or regulatory body?

Yes
No

6. Have you been censured, fined, or reprimanded by any professional credentialing organization of which you are a member?

Yes
No

If you answer "Yes" to any of these disclosure questions,
you must set forth the principal facts relating to each incident.