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OCHC Application

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First Name:

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Last Name:

Male Female

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Address:

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City:

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Province:

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Postal Code:

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Home Phone:

Work Phone:

Cell Phone:

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Email:

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Date of Birth (yy/mm/dd):

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Country of Origin:

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Arrival Date in Canada (yy/mm/dd):

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Immigration Status:

 Visitor Permit
 Study Permit
 Work Permit
 Family Class
 Refugee
 Independent
 Canadian Citizen
 Other

Languages spoken:

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If English is not your first language, was a language proficiency test completed?


Yes No

Most Recent Language Test Completed:

 TOEFL
 IELTS
 MELAB
 TOEIC
 CanTEST
 CLBA
 CELBAN

Date of most recent language test completed:

Scores(s):

Listening Score:

Reading Score:

Writing Score:

Speaking Score:

Overall Score:

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Health Care Profession:

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Current Occupation:

Current status towards obtaining professional licensure:

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Have you contacted the professional association in your province for information regarding the licensure process for your profession?

Yes No

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Have you  been connected with an employment counselor at the settlement agency in your province?

Yes No

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Have you completed any other programs for internationally educated health professionals?

 

Yes No

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How did you learn about this program?

 Regulatory Body
 Settlement Agency
 Colleague/Friend
 Website
 Pamphlet/Flyer
 Other

Why do you want to take this program? 

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What do you want to learn from the orientation program? Please be specific.

If you have any profession specific questions at this time, please list them here: