Registration and

Licensure as a

Pharmacy Technician

For applicants who have studied in Canada or worked in the field of pharmacy and are not licensed to practise as a pharmacy technician in any jurisdiction.

New Brunswick College of Pharmacists-December 2014 Page 2

Please read all pages carefully to be sure you understand the

requirements to be registered and licensed as a

pharmacy technician in New Brunswick.

Table of Contents

Contents Application Requirements ........................................................................................................................................ 3

Application Form ....................................................................................................................................................... 5

Certification statements ............................................................................................................................................ 6

Statutory Declaration of Good Character .................................................................................................................. 7

In the Regulations of the New Brunswick College of Pharmacists, Section 25.1 states pharmacy technicians must be covered by personal professional liability (errors and omissions) insurance that (b) for pharmacy technicians, pharmacist students and pharmacy technician students provides a minimum of $1,000,000 per claim or per occurrence and a minimum $2,000,000 annual aggregate;

For more information about the

New Brunswick College of Pharmacists, please visit

www.nbpharmacists.ca

New Brunswick College of Pharmacists-December 2014 Page 3

Application Requirements (Regulations 12.1, 12.2, 12.3)

1. (Select either a or b)

a ) Successful completion of a pharmacy education program approved by the Canadian

Council for Accreditation of Pharmacy Programs (CCAPP). (Path 2)

b) Proof of successful completion of the four bridging modules and the PEBC

pharmacy technician evaluating exam. (Path 1)

2. Registration as a Pharmacy Technician Student with the NB College of Pharmacists. (for more information, refer to Pharmacy Technician Student Application Package)

3. Successful completion of the NB College of Pharmacists practical training requirements.

[Regulation 12.19 (3)] 4. (Select either a or b)

a ) Successful completion of the NB College of Pharmacists Structured Practical Evaluation (SPE) for Path 2 applicants.

b) Successful completion of the NB College of Pharmacists Pharmacy Technician Assessment (PTA) for Path 1 applicants.

5. Successful completion of the PEBC Pharmacy Technician Qualifying Exam, Part 1 and Part 2.

6. Successful completion of the NB College of Pharmacists Pharmacy Technician Jurisprudence Exam.

7. Completed application form for Registration and Licensure as a Pharmacy Technician with the NB College of Pharmacists.

Proof of identity: You must provide identification documents that prove your legal name and date of birth and that preferably contain a photo. Valid Canadian or provincial government-issued photo ID (such as a passport or driver’s license) are accepted. Canadian Birth or Citizenship Certificates may be accepted if accompanied by a notarized passport-sized photo of the applicant.

NOTE: A copy of the identification document(s) will only be accepted if they are an exact replica and have been notarized* by a Commissioner of Oaths or a lawyer. The copied photo must be clear enough to identify the applicant or it will be rejected.

9. Language Proficiency: Must be proficient in either of Canada’s official languages (English or French)

10. Criminal Record Check Original document required; dated within 6 months prior to application date. (Royal Canadian Mounted Police (RCMP) or any other Canadian police service (includes a Canadian Police Information Centre (CPIC) assessment) documenting that you do not have a record of conviction under the Criminal Code (Canada), the Controlled Drugs and Substances Act (Canada), the Food and Drugs Act (Canada).

11. Proof of certification in First Aid & CPR* Equivalent to Red Cross Emergency First Aid & CPR Level C

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12. Personal Liability Insurance - (minimum $1,000,000 per claim or per occurrence and a minimum

$2,000,000 annual aggregate)

13. Signed Certification Statement

14. Signed Statutory Declaration of Good Character

15. Read the Policy Statement and the Privacy Policy (https://nbcp.in1touch.org/document/2373/Privacy%20Policy%20Approved%20Nov2015%20EN_grb.pdf)

16. Signed statement regarding the NBCP Policy Statement and Privacy Policy

17. Payment of all applicable fees

A licence to practise as a pharmacy technician in New Brunswick expires on December 31st and must be

renewed each year. The requirements to renew this licence to practise include maintaining a Continuing

Professional Development portfolio, requirements for practice in Direct Client Care and certification in First

Aid and CPR.

Please contact the office if you have any questions about the registration process, or require additional information.

Email: info@nbpharmacists.ca Phone: 506-857-8957

New Brunswick College of Pharmacists-December 2014 Page 5

Application Form

Pharmacy Technician Registration and Licensure (For applicants who have studied in Canada or worked in the field of pharmacy and are not licensed as pharmacy technician in any jurisdiction)

*All fields must be complete SECTION 1 (Please print)

First Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Middle Name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Last Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Street Address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Apt. #: . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

City: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Province: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Postal Code: . . . . . . . . . . . . . . . . . . . . . .

Phone (home): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Phone (cell): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

E-mail address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Date of Birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Gender: Male Female Year Month Day

PEBC Certification #...............................................

Place of Birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . City, Province and Country

SECTION 2-Complete this section if you have graduated from an accredited pharmacy technician program.

Name of Institution:________________________________________________________

My date of graduation was: ……………….. ……………… …………………

Year Month Day

A notarized copy of your certificate of graduation must accompany this application.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Signature of Applicant Date

Payment must be included at time of application. See the Fee Schedule on website for

applicable fee. Cheque, MasterCard or Visa are acceptable forms of payment.

Cheque is attached

I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . authorize the New Brunswick College of (Name as it appears on credit card)

Pharmacists to use my credit card:

Credit Card #: .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Expires (mm/yy): .. . . . . . . . . . . .

3-digit code on back of card: ... . . . . .

Telephone: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

to pay the registration fees associated with the attached application/request.

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Authorized Signature Date

Le paiement doit accompagner le formulaire. Voir la Liste de cotisations sur notre site Web

pour connaître les frais applicables. Les modalités acceptables de paiement sont les suivantes :

chèque, MasterCard ou Visa.

Le chèque est joint

Je . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . autorise l’Ordre des pharmaciens du Nouveau-Brunswick

(le nom tel qu'il apparait sur la carte)

Nº de carte de crédit .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Exp : . . . . . . . . . . .

Code à 3 chiffres au dos de la carte: .. . . . . . . . . . . . .

Téléphone : .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

payé les frais d'inscription associés à la demande ci-jointe.

…………………………………………… ………………………………………….

Signature Autorisé Date

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Certification statements

I HEREBY CERTIFY THAT:

• I have sufficient ability to:

Speak: English Read: English

French French

as to be competent to discharge my duties and obligations as a member of the

New Brunswick College of Pharmacists.

• I am a: Canadian citizen Resident of Canada

Landed Immigrant

• I have never been licensed to practice as a pharmacy technician in any jurisdiction. • I meet all the requirements necessary for registration/licensure as specified in the Pharmacy Act and

Regulations of the New Brunswick College of Pharmacists.

• Have you ever been convicted of an offence under the Controlled Drugs and Substances Act or the

Food and Drugs Act? (See application requirements for Criminal Record Check).

No

Yes (if yes, provide particulars thereof on the back of this page)

Date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Signature: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Statutory Declaration of Good Character

I, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . declare that

1. I have not been convicted in Canada or elsewhere of any offence that, if committed by a person registered under the

Pharmacy Act, or any other profession or occupation, would constitute unprofessional conduct or conduct unbecoming of a person registered under these regulations.

2. My entitlement to practice pharmacy or any other health profession has not been limited, restricted or subject to any

terms, limits or conditions or disciplinary action in any jurisdiction at any time.

3. At the present time, no investigation, review or proceeding is taking place in any jurisdiction which could result in the suspension or cancellation of my authorization to practice pharmacy or any other health profession.

4. My past conduct does not demonstrate any pattern of incompetence or untrustworthiness, which would make

registration contrary to the public interest.

5. I am aware of and will practice at all times in compliance with the Pharmacy Act and the Regulations of the New Brunswick College of Pharmacists.

6. I shall provide the Registrar with the details of any action impacting on the above statements that relate to me, or that occur or arise prior, during, or after my registration with the New Brunswick College of Pharmacists:

On a separate sheet of paper, provide details if any of the above are not true. Details to include:

a. Criminal offence/Disciplinary action/Investigation b. Date when offence was committed/Applicable health profession/Applicable jurisdiction c. Disposition of charge including details of penalty-imposed d. Extenuating circumstances you wish taken into account for your application.

I hereby declare, as indicated by my signature below, that the contents of this application are true and complete to the best of my knowledge and belief.

I understand and agree that if I make a false or misleading statement or representation in respect of my application, I shall be deemed not to have satisfied the requirements for registration/licensure.

I further understand and agree that if registration/licensure is issued to me based upon a false or misleading statement or representation that registration/licensure is subject to immediate cancellation.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name (please print) Signature

Dated at (city). . . . . . . . . . . . . . . . . . . . . . ……. . . . . . . . . . . . . . . . . this . . . . . . . . day of(month) . . . . . . . . . . . . . . . . . . . . . .. . . . . 20. . . . . . . . . .

New Brunswick College of Pharmacists-December 2014 Page 8