CLPNA Committee Volunteer Application Form 2025 - 2026

Application Information

Please use this form to apply for CLPNA Committee positions for the January 2025 to December 2026 term.

This application and your resume will be screened by the CLPNA's Committee Recruitment team prior to being presented to Council for consideration for appointment.

The CLPNA is committed to safeguarding your personal information. We will manage this information in accordance with the Personal Information Protection Act (PIPA) and other applicable laws. For more information on the CLPNA's Privacy Policy, please refer to our website at: https://www.clpna.com/about-clpna/privacy-policies/

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* 1. Your Contact Information

CLPNA Registration #:

First Name:

Last Name:

Mailing Address:

City:

Province:

Postal Code:

Email Address:

Daytime Phone Number:

Name of Primary Employer (facility name):

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* 2. Upload your Resume

Resumes should be in Word or PDF format. (File size limit is 16MB)

PDF, DOCX, DOC file types only.

Choose File

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* 3. Do you have an Active Practice Permit from the CLPNA?

Yes

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* 4. What year did you graduate as an nurse?

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* 5. What year did you become a CLPNA Member?

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* 6. Do you hold any of the following Advanced Authorizations?

Advanced Practice Orthopedic Nursing

Advanced Practice Perioperative Nursing

Advanced Practice Foot Care

N/A