Membership Application "*" indicates required fields Step 1 of 19 0% Your enrolment in the Ontario Approved Professionals Inc. program will be considered “Pending” until the following criteria has been supplied in complete form and our review and validation process has been completed.Section 1a - Company Information & Division Selection(as applicable to the company)Business Category / Type of Services:*If you cannot find a category, please select "other" to provide oneSelect3D RenderingAdvertisingAudiology, ServicesAutomotive Sales / ServiceBookkeeperBuilding ContractorBuildings (Timber)Business ConsultantCarpenterChiropracticCleaning Services, CommercialCleaning Services, ResidentialCommercial Cleaning ServicesCommunicationsComputer RepairComputer TrainingConcrete FoundationsCustom FramingElectrical ContractorEmbroideryEnergy / Fuel ServicesEngineer, Structural EngineeringEngravingEstate PlanningEstheticsExcavating ServicesFinancial PlanningFlooring / WoodFoundations / Helical PilesGarage Door ContractorGenerator Sales, Service & RentalsGovernment Service ProviderGraphic DesignGroup BenefitsHair and Beauty SalonHealth & SafetyHealth Care ClinicHealth Care ServicesHearing CentreHeating & CoolingHome Staging ServicesHuman Resource, ConsultantInsuranceInsurance, GeneralInsurance, Insurance BrokerInternet Service ProviderLandscaping ServicesLegal & Mediation ServicesLocksmithsManaged IT ServicesMarketing & BrandingMassage TherapyMediaMortgage, Mortgage AgentMortgage, Mortgage BrokerMosquito & Tick ServicesNutritionOnline MarketingPainting ContractorPersonal TrainingPhotographyPlumbing ContractorPrint / Copy / Scan ServicesPromotional ProductsProperty ManagementReal Estate, BrokerReal Estate, GeneralRenovation ContractorResidential DesignResidential Design FirmRetirement Planning, Estate Planning, Financial PlanningRisk Management ConsultingRoofing ContractorSafety Supplies & SalesScreen PrintingSecuritySigns - General / CommercialSigns - Vehicle WrapsSocial Media ConsultantSports TherapySunroomsTax Consultants & SpecialistsTelecommunicationsTelephone Service ProviderTelevision Service ProviderTiny Home Specialist / ManufacturerTravel Agent / AgencyWebsite Design & ServicesWindows & DoorsOtherOther Business Category /Type of Service* Company Name:* Registered Owner:* Registered Owner Title:* Company Email:* Company Website: Office Phone:*Ext. Other Phone:Ext. Company Mailing Address* Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Year Established:* Were you referred to the Program?* Yes No If Yes, by whom? Were you Recruited to the Program?* Yes No If Yes, who was your Recruiter? Facebook Link Instagram Link LinkedIn Link Other Social Media Link: Has the Company or Applicant ever been an Approved Member in the Past?* Yes No If Yes, please explain Section 1b – Program & Division SelectionHiddenPrimary Home Base Division Selection* Divisional: Leeds & Grenville Divisional: Ottawa, Orleans, Nepean Divisional: Kingston, South Frontenac Divisional: Stormont, Dundas, Glengarry Confirm # of Applicants for this Company*Complete with Names of Primary and Add-On Applicants Add-On Applicant Name 1 Add-On Applicant Name 1 Add-On Applicant Name 1 Add-On Applicant Name 1 Add-On Applicant Name 1 Add-On Applicant Name 1 Add-On Applicant Name 1 Add-On Applicant Name 1 Add-On Applicant Name 1 Section 2 – Integrity & Public Accountability1) In connection with your employment or business affairs have you, or any company in which you have a direct or indirect controlling interest, in Ontario or elsewhere: a) been charged with (where charges are still outstanding and unresolved) or convicted of an offence under the Criminal Code (Canada) in respect of which a pardon has not been granted or issued under the Criminal Records Act (Canada)?* Yes No b) been charged with (where charges are still outstanding and unresolved) or convicted of an offence under any other Federal statute, including but not limited to the Income Tax Act, in respect of which a pardon has not been granted or issued under the Criminal Records Act (Canada)?* Yes No 2) Have you been charged with (where charges are still outstanding and unresolved) or been disciplined by any professional association or body?* Yes No 3) Have you been involved in any issue or controversy in the past, or that may be subject to public review in the future, in which the government may have an interest?* Yes No If YES to any of the above, please explain:4) Do you perform criminal checks on your employees?* Yes No *Information will remain confidential; no information from Section 2b will be released.Section 3 – Company Details & SpecificsCurrent no. of active employee(s)* 1 to 5 5 to 10 10 to 25 25 to 50 50 to 100 100 or greater Approx. annual revenue dollars ($)* Under $100,000 $100,000 to $200,000 $200,000 to $500,000 $500K or greater *Information will remain confidential; no information from Section 3 will be released Section 4 – Client References(if confidential, you may skip)Please provide us with references from two (2) clients that you have completed work for in the past 12 months. Please refrain from using family members.Client Reference #1Name First Last Contact PhoneExt Contact Email Description of Work Project Location Date of project/contract MM slash DD slash YYYY Reference aware of Application? Yes No Other Is the project / contract complete? Yes No Other Client Reference #2Contact Name First Last Contact PhoneExt Contact Email Description of Work Project Location Date of project/contract MM slash DD slash YYYY Reference aware of Application? Yes No Other Is the project / contract complete? Yes No Other *Names & contact information required only – membership services will contact Reference. Section 5 – Company/Professional ReferencesPlease provide us with references from two (2) businesses/suppliers that you have completed work with in the past 12 months. Please refrain from using family members.Professional Reference #1Company name Contact name Contact PhoneExt Contact Email Affiliation Year(s) Affiliated Other Notes Reference aware of Application? Yes No Other Professional Reference #2Company name Contact name Contact PhoneExt Contact Email Affiliation Year(s) Affiliated Other Notes Reference aware of Application? Yes No Other *Names & contact information only required – membership services will contact References as required. Primary ApplicantSection 6a – Professional Contact Information*as applicable to primary applicantApplicant Name* First Last Title Applicant Office Phone*Ext Applicant Other PhoneExt Applicant Email* Professional head shot(high resolution, JPG and/or PDF)Accepted file types: jpg, png, Max. file size: 1 MB.Applicant Business Mailing Addressif different from company mailing address Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Year in this Profession Which division(s) is this applicant applying to be represented within?* Provincial: Ontario *includes Four Active Divisions of your choice Divisional: Leeds & Grenville Divisional: Ottawa, Orleans, Nepean Divisional: Kingston South Frontenac Divisional: Stormont, Dundas, Glengarry Section 6b – Insurance Information(as applicable to yourself & your profession)6b.1Type of insurance Provider Policy ID PhoneExt Proof of Insurance (PDF)Accepted file types: pdf, Max. file size: 1 MB.Renewal Date YYYY dash MM dash DD 6b.2Type of insurance Provider Policy ID PhoneExt Proof of Insurance (PDF)Accepted file types: pdf, Max. file size: 1 MB.Renewal Date YYYY dash MM dash DD Do you have additional insurances or coverages?* Yes No Not Required If Yes please explain & provide details Are you required to have WSIB?* Yes Not Required Unsure WSIB number/clearance ID Section 6c – Accreditations / Education*as applicable to primary applicant / professional6c.1Type of Accrediation/Education Accreditation Education Other Type Institution / Authority Reference ID / # Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.6c.2Type of Accrediation/Education Accreditation Education Other Type Institution / Authority Reference ID / # Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.6c.3Type of Accrediation/Education Accreditation Education Other Type Institution / Authority Reference ID / # Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.Add Add-On applicant? Yes Add-On Applicant #1 (if applicable)Section 6a – Professional Contact Information**as applicable to additional applicantApplicant Name First Last Title Applicant Office PhoneExt Applicant Other PhoneExt Applicant Email* Professional head shot(high resolution, JPG and/or PDF)Accepted file types: jpg, png, Max. file size: 1 MB.Applicant Business Mailing Address:if different from company mailing address Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Year in this Profession Which division(s) is this applicant applying to be represented within? Provincial: Ontario *includes Four Active Divisions of your choice Divisional: Leeds & Grenville Divisional: Ottawa, Orleans, Nepean Divisional: Kingston South Frontenac Divisional: Stormont, Dundas, Glengarry Section 6b – Insurance Information(as applicable to yourself & your profession) 6b.1Type of Insurance Provider Policy ID PhoneExt Proof of Insurance (PDF)Accepted file types: pdf, Max. file size: 1 MB.Renewal Date YYYY dash MM dash DD 6b.2Type of insurance Insurance company Policy number PhoneExt Proof of Insurance (PDF)Accepted file types: pdf, Max. file size: 1 MB.Renewal Date YYYY dash MM dash DD Do you have additional insurances or coverages? Yes No Not Required If Yes please explain & provide details Are you required to have WSIB? Yes Not Required Unsure WSIB number/clearance ID Section 6c – Professional Accreditations/Education(as applicable to yourself & your profession)6c.1Type of Accrediation/Education Accreditation Education Other Type Institution/Authority Reference ID / # Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.6c.2Type of Accrediation/Education Accreditation Education Other Type Institution/Authority Reference ID / # Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.6c.3Type of Accrediation/Education Accreditation Education Other Type Institution/Authority Reference ID / # Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.Add 2nd Add-On Applicant? Yes Add-On Applicant #2 (if applicable)Section 6a – Your Professional Contact Information(as applicable to yourself & your profession)Applicant Name First Last Title Applicant Office PhoneExt Applicant Other PhoneExt Applicant Email* Professional head shot(high resolution, JPG and/or PDF)Accepted file types: jpg, png, Max. file size: 1 MB.Applicant Business Mailing Address:if different from company mailing address Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Year in this Profession Which division(s) is this applicant applying to be represented within? Provincial: Ontario *includes Four Active Divisions of your choice Divisional: Leeds & Grenville Divisional: Ottawa, Orleans, Nepean Divisional: Kingston South Frontenac Divisional: Stormont, Dundas, Glengarry Section 6b – Insurance Information(as applicable to yourself & your profession) 6b.1Type of insurance Insurance company Policy number PhoneExt Proof of Insurance (PDF)Accepted file types: pdf, Max. file size: 1 MB.Renewal Date YYYY dash MM dash DD 6b.2Type of insurance Insurance company Policy number PhoneExt Proof of Insurance (PDF)Accepted file types: pdf, Max. file size: 1 MB.Renewal Date YYYY dash MM dash DD Do you have additional insurances or coverages? Yes No Not Required If Yes please explain & provide details Are you required to have WSIB? Yes Not Required Unsure WSIB number/clearance ID Section 6c – Professional Accreditations/Education(as applicable to yourself & your profession)6c.1Type of Accrediation/Education Accreditation Education Other Type Institution/Authority Reference ID / # Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.6c.2Type of Accrediation/Education Accreditation Education Other Type Institution/Authority Reference ID / # Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.6c.3Type of Accrediation/Education Accreditation Education Other Type Institution/Authority Reference ID / # Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.Add 3rd Add-On Applicant? Yes Add-On Applicant #3 (if applicable)Section 6a – Your Professional Contact Information (as applicable to yourself & your profession)Applicant Name First Last Title Applicant Office PhoneExt Applicant Other PhoneExt Applicant Email* Professional head shot(high resolution, JPG and/or PDF)Accepted file types: jpg, png, Max. file size: 1 MB.Applicant Business Mailing Address:if different from company mailing address Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Year in this Profession Which division(s) is this applicant applying to be represented within? Provincial: Ontario *includes Four Active Divisions of your choice Divisional: Leeds & Grenville Divisional: Ottawa, Orleans, Nepean Divisional: Kingston South Frontenac Divisional: Stormont, Dundas, Glengarry Section 6b – Insurance Information(as applicable to yourself & your profession)6b.1Type of insurance Insurance company Policy number PhoneExt Proof of Insurance (PDF)Accepted file types: pdf, Max. file size: 1 MB.Renewal Date YYYY dash MM dash DD 6b.2Type of insurance Insurance company Policy number PhoneExt Proof of Insurance (PDF)Accepted file types: pdf, Max. file size: 1 MB.Renewal Date YYYY dash MM dash DD Do you have additional insurances or coverages? Yes No Not Required If Yes please explain & provide details Are you required to have WSIB? Yes Not Required Unsure WSIB number/clearance ID Section 6c – Professional Accreditations/Education(as applicable to yourself & your profession)6c.1Type of Accrediation/Education Accreditation Education Other Type Institution/Authority Reference ID / # Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.6c.2Type of Accrediation/Education Accreditation Education Other Type Institution/Authority Reference ID / # Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.6c.3Type of Accrediation/Education Accreditation Education Other Type Institution/Authority Reference ID / # Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.Add 4th Add-On Applicant? Yes Add-On Applicant #4 (if applicable)Section 6a – Your Professional Contact Information (as applicable to yourself & your profession)Applicant Name First Last Title Applicant Office PhoneExt Applicant Other PhoneExt Applicant Email* Professional head shot(high resolution, JPG and/or PDF)Accepted file types: jpg, png, Max. file size: 1 MB.Applicant Business Mailing Address:if different from company mailing address Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Year in this Profession Which division(s) is this applicant applying to be represented within? Provincial: Ontario *includes Four Active Divisions of your choice Divisional: Leeds & Grenville Divisional: Ottawa, Orleans, Nepean Divisional: Kingston South Frontenac Divisional: Stormont, Dundas, Glengarry Section 6b – Insurance Information(as applicable to yourself & your profession)6b.1Type of insurance Insurance company Policy number PhoneExt Proof of Insurance (PDF)Accepted file types: pdf, Max. file size: 1 MB.Renewal Date YYYY dash MM dash DD 6b.2Type of insurance Insurance company Policy number PhoneExt Proof of Insurance (PDF)Accepted file types: pdf, Max. file size: 1 MB.Renewal Date YYYY dash MM dash DD Do you have additional insurances or coverages? Yes No Not Required If Yes please explain & provide details Are you required to have WSIB? Yes Not Required Unsure WSIB number/clearance ID Section 6c – Professional Accreditations/Education(as applicable to yourself & your profession)6c.1Type of Accrediation/Education Accreditation Education Other Type Institution/Authority Reference ID / # Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.6c.2Type of Accrediation/Education Accreditation Education Other Type Institution/Authority Reference ID / # Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.6c.3Type of Accrediation/Education Accreditation Education Other Type Institution/Authority Reference ID / # Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.Add 5th Add-On Applicant? Yes Add-On Applicant #5 (if applicable)Applicant Name First Last Title Applicant Office PhoneExt Applicant Other PhoneExt Applicant Email* Professional head shot(high resolution, JPG and/or PDF)Accepted file types: jpg, png, Max. file size: 1 MB.Applicant Business Mailing Address:if different from company mailing address Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Year in this Profession Which division(s) is this applicant applying to be represented within? Provincial: Ontario *includes Four Active Divisions of your choice Divisional: Leeds & Grenville Divisional: Ottawa, Orleans, Nepean Divisional: Kingston South Frontenac Divisional: Stormont, Dundas, Glengarry Section 6b – Insurance Information(as applicable to yourself & your profession)6b.1Type of insurance Insurance company Policy number PhoneExt Proof of Insurance (PDF)Accepted file types: pdf, Max. file size: 1 MB.Renewal Date YYYY dash MM dash DD 6b.2Type of insurance Insurance company Policy number PhoneExt Proof of Insurance (PDF)Accepted file types: pdf, Max. file size: 1 MB.Renewal Date YYYY dash MM dash DD Do you have additional insurances or coverages? Yes No Not Required If Yes please explain & provide details Are you required to have WSIB? Yes Not Required Unsure WSIB number/clearance ID Section 6c – Professional Accreditations/Education(as applicable to yourself & your profession)6c.1Type of Accrediation/Education Accreditation Education Other Type Institution/Authority Reference ID / # Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.6c.2Type of Accrediation/Education Accreditation Education Other Type Institution/Authority Reference ID / # Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.6c.3Type of Accrediation/Education Accreditation Education Other Type Institution/Authority Reference ID / # Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.Add 6th Add-On Applicant? Yes Add-On Applicant #6 (if applicable)Applicant Name First Last Title Applicant Office PhoneExt Applicant Other PhoneExt Applicant Email* Professional head shot(high resolution, JPG and/or PDF)Accepted file types: jpg, png, Max. file size: 1 MB.Applicant Business Mailing Address:if different from company mailing address Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Year in this Profession Which division(s) is this applicant applying to be represented within? Provincial: Ontario *includes Four Active Divisions of your choice Divisional: Leeds & Grenville Divisional: Ottawa, Orleans, Nepean Divisional: Kingston South Frontenac Divisional: Stormont, Dundas, Glengarry Section 6b – Insurance Information(as applicable to yourself & your profession)6b.1Type of insurance Insurance company Policy number PhoneExt Proof of Insurance (PDF)Accepted file types: pdf, Max. file size: 1 MB.Renewal Date YYYY dash MM dash DD 6b.2Type of insurance Insurance company Policy number PhoneExt Proof of Insurance (PDF)Accepted file types: pdf, Max. file size: 1 MB.Renewal Date YYYY dash MM dash DD Do you have additional insurances or coverages? Yes No Not Required If Yes please explain & provide details Are you required to have WSIB? Yes Not Required Unsure WSIB number/clearance ID Section 6c – Professional Accreditations/Education(as applicable to yourself & your profession)6c.1Type of Accrediation/Education Accreditation Education Other Type Institution/Authority Reference ID / # Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.6c.2Type of Accrediation/Education Accreditation Education Other Type Institution/Authority Reference ID / # Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.6c.3Type of Accrediation/Education Accreditation Education Other Type Institution/Authority Reference ID / # Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.Add 7th Add-On Applicant? Yes Add-On Applicant #7 (if applicable)Applicant Name First Last Title Applicant Office PhoneExt Applicant Other PhoneExt Applicant Email* Professional head shot(high resolution, JPG and/or PDF)Accepted file types: jpg, png, Max. file size: 1 MB.Applicant Business Mailing Address:if different from company mailing address Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Year in this Profession Which division(s) is this applicant applying to be represented within? Provincial: Ontario *includes Four Active Divisions of your choice Divisional: Leeds & Grenville Divisional: Ottawa, Orleans, Nepean Divisional: Kingston South Frontenac Divisional: Stormont, Dundas, Glengarry Section 6b – Insurance Information(as applicable to yourself & your profession)6b.1Type of insurance Insurance company Policy number PhoneExt Proof of Insurance (PDF)Accepted file types: pdf, Max. file size: 1 MB.Renewal Date YYYY dash MM dash DD 6b.2Type of insurance Insurance company Policy number PhoneExt Proof of Insurance (PDF)Accepted file types: pdf, Max. file size: 1 MB.Renewal Date YYYY dash MM dash DD Do you have additional insurances or coverages? Yes No Not Required If Yes please explain & provide details Are you required to have WSIB? Yes Not Required Unsure WSIB number/clearance ID Section 6c – Professional Accreditations/Education(as applicable to yourself & your profession)6c.1Type of Accrediation/Education Accreditation Education Other Type Institution/Authority Reference ID / # Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.6c.2Type of Accrediation/Education Accreditation Education Other Type Institution/Authority Reference ID / # Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.6c.3Type of Accrediation/Education Accreditation Education Other Type Institution/Authority Reference ID / # Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.Add 8th Add-On Applicant? Yes Add-On Applicant #8 (if applicable)Applicant Name First Last Title Applicant Office PhoneExt Applicant Other PhoneExt Applicant Email* Professional head shot(high resolution, JPG and/or PDF)Accepted file types: jpg, png, Max. file size: 1 MB.Applicant Business Mailing Address:if different from company mailing address Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Year in this Profession Which division(s) is this applicant applying to be represented within? Provincial: Ontario *includes Four Active Divisions of your choice Divisional: Leeds & Grenville Divisional: Ottawa, Orleans, Nepean Divisional: Kingston South Frontenac Divisional: Stormont, Dundas, Glengarry Section 6b – Insurance Information(as applicable to yourself & your profession)6b.1Type of insurance Insurance company Policy number PhoneExt Proof of Insurance (PDF)Accepted file types: pdf, Max. file size: 1 MB.Renewal Date YYYY dash MM dash DD 6b.2Type of insurance Insurance company Policy number PhoneExt Proof of Insurance (PDF)Accepted file types: pdf, Max. file size: 1 MB.Renewal Date YYYY dash MM dash DD Do you have additional insurances or coverages? Yes No Not Required If Yes please explain & provide details Are you required to have WSIB? Yes Not Required Unsure WSIB number/clearance ID Section 6c – Professional Accreditations/Education(as applicable to yourself & your profession)6c.1Type of Accrediation/Education Accreditation Education Other Type Institution/Authority Reference ID / # Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.6c.2Type of Accrediation/Education Accreditation Education Other Type Institution/Authority Reference ID / # Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.6c.3Type of Accrediation/Education Accreditation Education Other Type Institution/Authority Reference ID / # Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.Add 9th Add-On Applicant? Yes Add-On Applicant #9 (if applicable)Applicant Name First Last Title Applicant Office PhoneExt Applicant Other PhoneExt Applicant Email* Professional head shot(high resolution, JPG and/or PDF)Accepted file types: jpg, png, Max. file size: 1 MB.Applicant Business Mailing Address:if different from company mailing address Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Year in this Profession Which division(s) is this applicant applying to be represented within? Provincial: Ontario *includes Four Active Divisions of your choice Divisional: Leeds & Grenville Divisional: Ottawa, Orleans, Nepean Divisional: Kingston South Frontenac Divisional: Stormont, Dundas, Glengarry Section 6b – Insurance Information(as applicable to yourself & your profession)6b.1Type of insurance Insurance company Policy number PhoneExt Proof of Insurance (PDF)Accepted file types: pdf, Max. file size: 1 MB.Renewal Date YYYY dash MM dash DD 6b.2Type of insurance Insurance company Policy number PhoneExt Proof of Insurance (PDF)Accepted file types: pdf, Max. file size: 1 MB.Renewal Date YYYY dash MM dash DD Do you have additional insurances or coverages? Yes No Not Required If Yes please explain & provide details Are you required to have WSIB? Yes Not Required Unsure WSIB number/clearance ID Section 6c – Professional Accreditations/Education(as applicable to yourself & your profession)6c.1Type of Accrediation/Education Accreditation Education Other Type Institution/Authority Reference ID / # Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.6c.2Type of Accrediation/Education Accreditation Education Other Type Institution/Authority Reference ID / # Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.6c.3Type of Accrediation/Education Accreditation Education Other Type Institution/Authority Reference ID / # Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.Add 10th Add-On Applicant? Yes Add-On Applicant #10 (if applicable)Applicant Name First Last Title Applicant Office PhoneExt Applicant Other PhoneExt Applicant Email* Professional head shot(high resolution, JPG and/or PDF)Accepted file types: jpg, png, Max. file size: 1 MB.Applicant Business Mailing Address:if different from company mailing address Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Year in this Profession Which division(s) is this applicant applying to be represented within? Provincial: Ontario *includes Four Active Divisions of your choice Divisional: Leeds & Grenville Divisional: Ottawa, Orleans, Nepean Divisional: Kingston South Frontenac Divisional: Stormont, Dundas, Glengarry Section 6b – Insurance Information(as applicable to yourself & your profession)6b.1Type of insurance Insurance company Policy number PhoneExt Proof of Insurance (PDF)Accepted file types: pdf, Max. file size: 1 MB.Renewal Date YYYY dash MM dash DD 6b.2Type of insurance Insurance company Policy number PhoneExt Proof of Insurance (PDF)Accepted file types: pdf, Max. file size: 1 MB.Renewal Date YYYY dash MM dash DD Do you have additional insurances or coverages? Yes No Not Required If Yes please explain & provide details Are you required to have WSIB? Yes Not Required Unsure WSIB number/clearance ID Section 6c – Professional Accreditations/Education(as applicable to yourself & your profession)6c.1Type of Accrediation/Education Accreditation Education Other Type Institution/Authority Reference ID / # Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.6c.2Type of Accrediation/Education Accreditation Education Other Type Institution/Authority Reference ID / # Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.6c.3Type of Accrediation/Education Accreditation Education Other Type Institution/Authority Reference ID / # Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB. Section 7 – Code of Conduct Agreement *MUST be initialed to be considered a complete application.As an Approved Member of the Approved Professionals Program, I/We have read the following Code of Conduct. I/We agree to follow and adhere to the best of my/our abilities. This Code of Conduct for all members of the program shall apply while serving the public as a professional. Service the clients with courtesy & respect. Maintain a clean, safe workplace. Present yourself in a tidy, clean & professional manor. Provide written quotes / estimates that are honest, accurate and accountable. Communicate project status with client on regular basis and upon modification. Complete work to an acceptable professional industry standard. Ensure all employees are trained to complete tasks assigned and to ensure a safe working environment. Maintain proper insurance and comply with all relevant regulations. Comply with all municipal by-laws and regulations. Encourage use of the Approved Professionals Program & network. Primary Applicant Initial* Add-On Applicant* Add-On Applicant #2* Add-On Applicant #3* Add-On Applicant #4* Add-On Applicant #5* Add-On Applicant #6* Add-On Applicant #7* Add-On Applicant #8* Add-On Applicant #9* Add-On Applicant #10* Section 8 – Revocation of Rights *MUST be initialed to be considered a complete application.I/We understand that failure to adhere to the Code of Conduct and/or Program Guidelines of the Approved Professionals Program will result in revocation / removal of membership. I/We understand that if for any reason the applicant(s) Approved Professional certification is revoked or cancelled, the applicant(s) has 15 days to cease and desist on all usage of the Approved Professionals logos, affiliations, and services. Failure to do so will result in possible legal action. Primary Applicant Initial* Add-On Applicant* Add-On Applicant #2* Add-On Applicant #3* Add-On Applicant #4* Add-On Applicant #5* Add-On Applicant #6* Add-On Applicant #7* Add-On Applicant #8* Add-On Applicant #9* Add-On Applicant #10* Section 9 – Sworn Declaration*MUST be signed to be considered a complete application.I (Primary Applicant), of (city) solemnly declare that all the information and statements contained in this application are true and complete. I make this solemn declaration conscientiously believing it to be true and knowing that it is of the same force and effect as if made under oath.Signature – Primary Applicant Date* MM slash DD slash YYYY Section 10 – Additional Company Profile Information*This content is required before Membership Services can board your company onto our system.Does your company have a company motto or slogan?Can you provide us with a bio or one paragraph write-up that will be used for advertising purposes and on the program website that would best describe your company, its services and history?Please ensure you provide us with the following as available and applicable: Company logo(high resolution, PSD, PDF and/or PNG)Accepted file types: psd, pdf, png, jpeg, jpg, Max. file size: 1 MB.Professional head shot(high resolution, JPG and/or PDF)Accepted file types: jpg, pdf, png, jpeg, Max. file size: 1 MB.Photo of your office/building/store front(high resolution, JPG and/or PDF)Accepted file types: jpg, pdf, png, jpeg, Max. file size: 1 MB.1 or 2 portfolio photos(high resolution, JPG and/or PDF) Drop files here or Select files Accepted file types: jpg, pdf, png, Max. file size: 1 MB, Max. files: 2. Section 11 – Consent to Email for Anti-Spam ComplianceThis consent will be required from all applicants and or staff members that wish to receive news, invitations, updates and all other means communications while an active member within the Approved Professionals. This consent will be required to be signed on an annual basis at time of renewal.As per the Canadian Anti-Spam Legislation, I give my consent to the Ontario Approved Professionals Program to communicate with me electronically. I understand that my consent may be withdrawn at any time by emailing the Ontario Approved Professionals Program.Primary Applicant Email Initial Add-On Applicant Email Initial Add-On Applicant #2 Email Initial Add-On Applicant #3 Email Initial Add-On Applicant #4 Email Initial Add-On Applicant #5 Email Initial Add-On Applicant #6 Email Initial Add-On Applicant #7 Email Initial Add-On Applicant #8 Email Initial Add-On Applicant #9 Email Initial Add-On Applicant #10 Email Initial Section 12 – Membership Level and Payment Information Provincial Membership $700.00 plus HST = $791.00 Application for the Province of Ontario. One (1) Year term agreement and per applicable program by-laws. Membership shall include selection of Four (4) active divisions within the Ontario Program Mapping. Membership Rate for One (1) Professional / Person. Additional Add-On Members not included (see below) Divisional Membership $375.00 plus HST Application for One (1) Division within the Province of Ontario. One (1) Year term agreement and per applicable program by-laws. Membership shall be limited to the selection of One (1) active division within the Ontario Program Mapping. Membership Rate for One (1) Professional / Person. Additional Add-On Members not included (see below) **Not applicable if Provincial is selectedPlease Select ONE Membership Level* Provincial Membership: $700.00 plus HST = $791.00 Divisional Membership: $375.00 plus HST = $423.75 Primary Division Selection* Divisional: Leeds & Grenville Divisional: Stormont, Dundas, Glengarry Divisional: Kingston, South Frontenac Divisional: Ottawa, Orleans, Nepean Provincial Memberships Divisions (Select up to 4)* Divisional: Leeds & Grenville Divisional: Stormont, Dundas, Glengarry Divisional: Kingston, South Frontenac Divisional: Ottawa, Orleans, Nepean HiddenPlease select your Primary / Home Division* Divisional: Leeds & Grenville Divisional: Stormont, Dundas, Glengarry Divisional: Kingston South Frontenac Divisional: Ottawa, Orleans, Nepean Additional Divisional Memberships Each selected Additional Division will be charged at $200.00+HST per Division. One (1) Year term agreement and per applicable program by-laws. Additional Divisional Membership Add-Ons Divisional: Leeds & Grenville Divisional: Stormont, Dundas, Glengarry Divisional: Kingston South Frontenac Divisional: Ottawa, Orleans, Nepean Add-On Member $56.50/Member Each requested Add-On Member will be charged at $50.00+HST per Person. Applicable to all Add-On’s in addition to Provincial or Divisional Memberships. One (1) Year term agreement and per applicable program by-laws. Sub-total [A] Membership LevelSub-total [A] Membership LevelSub-total [B] Additional DivisionsSub-total [C] Add-on MembersGrand TotalMembership shall not be activated or deemed complete until all fees have been paid in full. Terms of Payment, Late Fees and Termination of Membership shall be as per the Program By-Laws. Δ