Have you previously been a member of the Manitoba Institute of Registered Social Workers or MCSW?
Are you now or have you been a registered, licensed or certified member of any other professional regulatory body?
Are you or have you been the subject of an investigation or proceeding relating to your ethical/professional conduct or suitability to practice social work in Canada or elsewhere?
Are you or have you been the subject of an evaluation or disciplinary action due to concerns regarding your professional conduct(i.e. verbal reprimand/warning, disciplinary letter, suspension, etc.)?
Are you or have you been the subject of a finding of conduct unbecoming or professional misconduct/incompetence?
Have you been involuntarily terminated from any social work or related employment/contract/volunteer work due to concerns regarding your professional conduct?
Have you surrendered or cancelled a license, certificate or registration by the issuing authority of any occupation or profession in Canada or elsewhere?
Have you been denied registration to practice in social work or any other profession in Canada or elsewhere?
Have you been convicted or pled guilty to a criminal offense, or to any other offense under a federal or provincial statute, other than a minor traffic violation?
Are you the subject of a current criminal investigation and/or do you have any outstanding charges, other than those related to a minor traffic violation that may be relevant to your suitability to practice social work?
Do you or have you had an emotional, physical/mental health or addiction issue that has or may have compromised your professional practice?
Do you have any personal or professional conditions that may create a risk to the public?
If approved for registration I agree to adhere to the Social Work Profession Act and the related Regulation and Bylaw.
If approved for registration I agree to adhere to the Manitoba College of Social Workers Standards of Practice and the Manitoba College of Social Workers Code of Ethics.
If approved I agree to adhere to the requirements of the MCSW Continuing Competence Program.
I agree to notify the College in writing immediately of any changes to any information provided on this application.
The information and documentation provided for the purpose of applying for registration with the College is accurate.
I understand false or misleading statements, representations or declarations relating to this application for registration are cause for denial or revocation of registration with the Manitoba College of Social Workers.
I authorize the College to contact any authority, institution, association, corporation, body or person in any jurisdiction to verify the information provided in this application. I authorize any such authority, institution, association, corporation, body or person to release to the College any information relevant to this application.
I authorize the College to include my highest verified social work university degree on the public registry of Social Workers.
I currently carry or agree to obtain Professional Liability Insurance (purchased independently or through my employer) at a minimum value of $2,000,000 for each position in which I function as a social worker (Practicing applicants only.)
Please Note: The Manitoba College of Social Workers is required to maintain a public registry including registrants' names, business addresses, business phone numbers and names of registrants' employers or businesses.
Manitoba College of Social Workers 101-2033 Portage Ave Winnipeg, Manitoba R3J OK6 P:204-888-9477 F:204-831-6359 email@example.com
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