Out of Province Candidates for License as Dispensing Optician and/or Contact Lens Fitter in the province of Newfoundland and Labrador.

Application Fee: $400.00 for Optician; $510.00 for Optician/Contact Lens Fitter [non-refundable]. Please pay by credit or e-transfer or make cheque payable to the Dispensing Opticians Board of Newfoundland and Labrador. [contact: info@opticiansnl.ca ]

Please complete this form, pay fee, and enclose pertinent documentation for preliminary consideration.

NAME:

ADDRESS:

Phone: (H):

E-mail(H)

Phone:(W)

Email(W)

Answer the following and provide requested documentation:

Please provide 2 passport photographs

Drop files here or

Max. file size: 64 MB, Max. files: 2.

[signed on front]

Please provide a current (within the past 3 months) affidavit for criminal / vulnerable sector clearance certificate

Max. file size: 5 MB.

[RNC, RCMP, or your (local) provincial police authority] Include this with your application.

Provide ‘letter of standing’/ reference from your current provincial authority,

Max. file size: 5 MB.

verifying your licensed status and registration/license number

Please enclose 3 letters of reference from members within your professional peer group who have worked with you within the past three (3) years including contact information.

Drop files here or

Max. file size: 5 MB, Max. files: 3.

Fellow employees, employer, other opticians, contact lens fitters, Optometrists, optical trades…

List the provinces in which you have held license.

[include year and registration / license number]

Are these licenses current at this time?

Yes

Do you intend to reside and work in Newfoundland and Labrador?

Yes

Have you accepted employment?

Yes

What is company name:

Work address:

Did you receive formal training as a Dispensing Optician?

Yes

Did you receive formal training as a Contact Lens Fitter?

Yes

Note: Submission of this application is your personal affidavit that the information provided is true and provides the authorization required by the Dispensing Opticians Board of NL to verify your professional status by contacting your references and regulatory bodies noted on this application. Once accepted you will complete forms for ’New Registrants’, attach documentation confirming you have Professional Liability Insurance [PLI] from the Newfoundland Guild of Dispensing Opticians and its co-partner, the Opticians Association of Canada. Eyeglass Dispensing; NL Optician requires $1 million policy; Contact Lens Dispensing requires $3 million policy. Contact the OAC for membership payments. www.opticians.ca All registrants are expected to complete continuing education requirements on annual basis. Registration period: July 1st to June 30th. You are expected to register within 12 months after your application has been approved. After that date, new application and fee will be required.

Applicant’s signature:

Max. file size: 5 MB.

Date