Membership Application Step 1 of 12 8% 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:*Select3D 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 Business Owner Name:* Email:* Website: Facebook Twitter Instagram LinkedIn Office Phone:*Ext. Other Phone:Ext. 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? Section 1b – Program & Division SelectionMembership level* Provincial: Ontario Divisional: Leeds & Grenville Divisional: Stormont, Dundas, Glengarry Divisional: Kingston, South Frontenac Divisional: Ottawa, Orleans, Nepean Division selection for participation* Leeds & Grenville Ottawa, Orleans, Nepean Kingston South Frontenac Stormont, Dundas, Glengarry All currently available divisions within Ontario Approved Professionals Do you wish to be contacted about representation in other divisions?* Leeds & Grenville Ottawa, Orleans, Nepean Kingston South Frontenac Stormont, Dundas, Glengarry Have you ever been an Approved member?* Yes No If Yes, please explain 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 plus Approx. annual revenue dollars ($)* Under $100,000 $100,000 to $200,000 $200,000 to $500,000 $500,000 plus *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 PhoneExt Email Project Description Project Location Date of Project MM slash DD slash YYYY Reference aware of Application? Yes No Is the project complete? Yes No Client Reference #2Name First Last PhoneExt Email Project Description Project Location Date of Project MM slash DD slash YYYY Reference aware of Application? Yes No Is the project complete? Yes No *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* Phone*Ext Email* Affiliation* Year(s) Affiliated* Comment(s): Reference aware of Application?* Yes No Professional Reference #2Company name Contact name PhoneExt Email Affiliation Year(s) Affiliated Comment(s) Reference aware of Application? Yes No *Names & contact information only required – membership services will contact References as required. Primary Applicant - Professional #1 Section 6a – Your Professional Contact Information(as applicable to yourself & your profession)Applicant Name* First Last Applicant 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 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 Which division(s) is this applicant applying to be represented within?* Leeds & Grenville Ottawa, Orleans, Nepean Kingston South Frontenac Stormont, Dundas, Glengarry All currently available divisions within Ontario Approved Professionals 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.6b.2Type of insurance Insurance company Policy number PhoneExt Proof of Insurance (PDF)Accepted file types: pdf, Max. file size: 1 MB.Do you have additional insurances or coverages?* Yes No If Yes please explain & provide details Are you required to have WSIB?* Yes No WSIB number/clearance ID Section 6c – Professional Accreditations/Education(as applicable to yourself & your profession)6c.1Type Institution / Authority ID / # Contact Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.6c.2Type Institution / Authority ID / # Contact Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.6c.3Type Institution / Authority ID / # Contact Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.Add another applicant? Yes Applicant #2 - Professional #2 (if applicable)Section 6a – Your Professional Contact Information(as applicable to yourself & your profession)Applicant Name First Last Applicant 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 Addressif different from company mailing address Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Which division(s) is this applicant applying to be represented within? Leeds & Grenville Ottawa, Orleans, Nepean Kingston South Frontenac Stormont, Dundas, Glengarry All currently available divisions within Ontario Approved Professionals 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.6b.2Type of insurance Insurance company Policy number PhoneExt Proof of Insurance (PDF)Accepted file types: pdf, Max. file size: 1 MB.Do you have additional insurances or coverages? Yes No If Yes please explain & provide details Are you required to have WSIB? Yes No WSIB number/clearance ID Section 6c – Professional Accreditations/Education(as applicable to yourself & your profession)6c.1Type Institution/Authority ID # Contact Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.6c.2Type Institution/Authority ID # Contact Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.6c.3Type Institution/Authority ID # Contact Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.Add 3rd applicant? Yes Applicant #3 - Professional #3 (if applicable)Section 6a – Your Professional Contact Information(as applicable to yourself & your profession)Applicant Name First Last Applicant 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 Addressif different from company mailing address Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Which division(s) is this applicant applying to be represented within? Leeds & Grenville Ottawa, Orleans, Nepean Kingston South Frontenac Stormont, Dundas, Glengarry All currently available divisions within Ontario Approved Professionals 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.6b.2Type of insurance Insurance company Policy number PhoneExt Proof of Insurance (PDF)Accepted file types: pdf, Max. file size: 1 MB.Do you have additional insurances or coverages? Yes No If Yes please explain & provide details Are you required to have WSIB? Yes No WSIB number/clearance ID Section 6c – Professional Accreditations/Education(as applicable to yourself & your profession)6c.1Type Institution/Authority ID # Contact Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.6c.2Type Institution/Authority ID # Contact Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.6c.3Type Institution/Authority ID # Contact Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.Add 4th applicant? Yes Applicant #4 - Professional #4 (if applicable)Section 6a – Your Professional Contact Information (as applicable to yourself & your profession)Applicant Name First Last Applicant 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 Addressif different from company mailing address Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Which division(s) is this applicant applying to be represented within? Leeds & Grenville Ottawa, Orleans, Nepean Kingston South Frontenac Stormont, Dundas, Glengarry All currently available divisions within Ontario Approved Professionals 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.6b.2Type of insurance Insurance company Policy number PhoneExt Proof of Insurance (PDF)Accepted file types: pdf, Max. file size: 1 MB.Do you have additional insurances or coverages? Yes No If Yes please explain & provide details Are you required to have WSIB? Yes No WSIB number/clearance ID Section 6c – Professional Accreditations/Education(as applicable to yourself & your profession)6c.1Type Institution/Authority ID # Contact Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.6c.2Type Institution/Authority ID # Contact Professional Accreditations / Education documentation (PDF)Accepted file types: pdf, Max. file size: 1 MB.6c.3Type Institution/Authority ID/# Contact 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 Professionals Program member, I have read the following Code of Conduct and agree to follow and adhere to the best of my abilities. This is a general Code of Conduct for all Professionals to follow while serving the public. 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 insurances 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* Applicant #2 Initial* Applicant #3 Initial* Applicant #4 Initial* Section 8 – Revocation of Rights *MUST be initialed to be considered a complete application.I understand that my failure to adhere to the guidelines of the Ontario Approved Professionals Program Code of Conduct will result in my removal from the Approved Professionals Program. I understand that if for any reason my company’s Approved Professional certification is revoked or cancelled, the company has 15 days to cease and desist on all usage of the Approved Professionals logo, references to affiliations and services. Failure to do so will result in possible legal actions. Primary Applicant Initial* Applicant #2 Initial* Applicant #3 Initial* Applicant #4 Initial* 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 – Profile Information for Approved Professional Members*This content is required before Membership Services can board your company onto our system.What year was your company established? How many years has the owner of the company been active in your primary business sector or profession? As the authorized Approved Member, what is your official title with the company?Professional #1 Professional #2 Professional #3 Professional #4 Professional #5 Professional #6 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 Compliance*This consent will be required from all applicants and or staff members that wish to receive news, invitations, updates and all other program communications while holding an active membership. ** This consent will be required to be signed on an annual basis at time of renewalAs 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 (Signature) Email address Dated* MM slash DD slash YYYY If you have additional employees or business contacts within the company that wish to also receive updates, information and/or event details, please list them below with authorization by each additional name via initial. *This consent will be required from all applicants and or staff members that wish to receive news, invitations, updates and all other program communications while holding an active membership. ** This consent will be required to be signed on an annual basis at time of renewal. (2) Additional email address:Contact name Email Initial (3) Additional email address:Contact name Email Initial (4) Additional email address:Contact name Email Initial (5) Additional email address:Contact name Email Initial Section 12 – Membership Level and Payment Information*Please Select ONE Membership Level* Provincial Membership: $700.00 plus HST = $791.00 Divisional Membership: $375.00 plus HST = $423.75 Divisional Membership with Add-On: = $375 plus $200.00 for each divisional add-on Please select your Primary Division:* Leeds & Grenville Stormont, Dundas, Glengarry Kingston South Frontenac Ottawa, Orleans, Nepean Provincial Membership $700.00 plus HST = $791.00 * This is for a 1 (one) year term agreement. ** Includes all currently active divisions within Ontario (at time of application). Leeds & Grenville, aka: LG Approved Stormont, Dundas, Glengarry, aka: SDG Approved Kingston South Frontenac, aka: KSF Approved Ottawa, Orleans, Nepean, aka: OON Approved Divisional Membership $375.00 plus HST * This is for a 1 (one) year term agreement. ** Includes only the division as selected below.Divisional Membership with Add-On $375.00 plus HST * This is for a 1 (one) year term agreement. ** Includes only the division as selected below. Division Add-On: $200.00 plus HST per divisionDivision Add-Ons Leeds & Grenville Stormont, Dundas, Glengarry Kingston South Frontenac Ottawa, Orleans, Nepean Grand Total* All invoices will be issued upon approval of membership. ** No payments are due until the process is deemed complete. Δ
