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2022 Application for Canadian Trained MLTs
Due to the CMLTA changing registration systems , this application form is being used as a temporary solution. Additional information may be requested by the CMLTA.
All documents must be in English. Any translated documents must be done by the ATIA (Association of Translators and Interpreters of Alberta) and notarized.
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Name
*
First
Last
Email
*
Email
Confirm Email
CMLTA Registration #
*
Your CMLTA registration # will be your CSMLS membership #.
Were you previously registered with the CMLTA?
Yes
No
What year were you last registered with the CMLTA?
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Address
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Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
--- Select country ---
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia (Plurinational State of)
Bonaire, Saint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo (Democratic Republic of the)
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Kingdom of)
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland (Republic of)
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea (Democratic People's Republic of)
Korea (Republic of)
Kosovo
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia (Federated States of)
Moldova (Republic of)
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia (Republic of)
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine (State of)
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Republic of China
Tajikistan
Tanzania (United Republic of)
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
Uganda
Ukraine
United Arab Emirates
United Kingdom of Great Britain and Northern Ireland
United States Minor Outlying Islands
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela (Bolivarian Republic of)
Vietnam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Phone
*
Date of Birth
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Gender
*
Female
Male
Other
Upload government issued photo identification
*
Click or drag a file to this area to upload.
Criminal Record Check
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Click or drag a file to this area to upload.
Upload a current (dated within 90 days of receipt of application) copy of your criminal record check. Contact your local police agency, RCMP, or backcheck.net to obtain this document. All associated costs are the responsibility of the applicant.
MLT Education
Provide the name of the educational institution where you completed your MLT diploma/degree.
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Upload a copy of your MLT diploma/degree.
*
Click or drag a file to this area to upload.
For recent graduates of CMLTA approved Canadian MLT education programs awaiting receipt of official diploma/degree, the CMLTA will accept a copy of unofficial transcripts in English stating the date the MLT diploma/degree was awarded in the interim. In lieu of a diploma/degree, the CMLTA will accept an official etranscript.
Language of MLT Instruction - was your MLT education in English?
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Yes
No
If your MLT education was not in English, upload proof of an English Language Assessment Test.
Click or drag a file to this area to upload.
Applicants whose formal MLT education was not obtained in English from a CMLTA approved Canadian MLT education program must provide evidence of competence in and comprehension of the English language substantiated by completion of one (1) of the following tests with minimum scores as stated in each component of assessment: a. International Language Testing Source (IELTS) (academic version) Listening: 7.0* Reading: 7.0* Writing: 7.0* Speaking: 7.0* Overall: 7.0* *The IELTS uses Standard Error of Measurement. b. Canadian Test of English for Scholars and Trainees (CanTEST) Listening: 4.0 Reading: 4.0 Writing: 4.0 Speaking: 4.0 c. Michener English Language Assessment (MELA) Listening: 8 Reading: 7 Writing: 7 Speaking: 8 Individual scores from components of different English language assessment tests cannot be combined to meet a composite minimum test score. All language test results are valid for two (2) years from the date the test was administered. The CMLTA may require a transcript be sent directly from the testing location as well.
CSMLS Certification
Do you have CSMLS certification?
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Yes
No
Upload a copy of your CSMLS certification or exam results.
*
Click or drag a file to this area to upload.
Upload a copy of your confirmation of exam registration email from the CSMLS.
*
Click or drag a file to this area to upload.
MLT Employment
Section 6 of the Medical Laboratory Technologists Profession Regulation pursuant to the Health Professions Act requires that all applicants for MLT registration must have been employed for at least 900 MLT hours in the previous four (4) years. Recent graduates (i.e. graduated within the previous four (4) years) from an approved Canadian MLT education program are exempt.
Please answer the following question. I have:
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Graduated within the past 4 years.
Worked at least 900 MLT hours in the past 4 years.
Worked some (but less than 900) MLT hours in the past 4 years and have completed the required refresher education.
Not worked at all in the past 4 years and have completed the required refresher education.
Validation of MLT Employment
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Letter of Standing from another regulated province
Letter from employer from an unregulated province or outside of Canada
N/A as hours are from Alberta
If you have worked as an MLT in another regulated province, please have a letter of standing sent directly to the CMLTA by email to info@cmlta.org.
Click or drag a file to this area to upload.
If you have worked as an MLT in an unregulated province or outside of Canada, please upload a copy of a letter in English on employer letterhead from your previous employer(s) verifying MLT employment, position title and position description of the MLT duties, and the total number of MLT practice hours worked for each year.
Refresher Education
*
Click or drag files to this area to upload.
You can upload up to 7 files.
If you have not worked at least 900 MLT hours in the past 4 years and have not graduated in the past 4 years, you must complete refresher education prior to applying for registration. Upload copies of official transcripts for the required courses.
Total MLT Hours Worked in 2022
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Enter '0' if not applicable
Province (or country) where you worked as an MLT in 2022
Total MLT Hours Worked in 2021
*
Enter '0' if not applicable
Province (or country) where you worked as an MLT in 2021
Total MLT Hours Worked in 2020
*
Enter '0' if not applicable
Province (or country) where you worked as an MLT in 2020
Total MLT Hours Worked in 2019
*
Enter '0' if not applicable
Province (or country) where you worked as an MLT in 2019
Total MLT Hours Worked in 2018
*
Enter '0' if not applicable
Province (or country) where you worked as an MLT in 2018
Declaration Questions
Authorization for registration with the CMLTA as a Medical Laboratory Technologist, including the collection and provision of certain information, is granted under Sections 9, 28, 29, 30, 33, 34, 36, 43, 44, 46, 47, 48, 119, 120, 122, 128, and 129 of the Health Professions Act, Sections 2 through 12.4, 23, 24, and 25 of the Medical Laboratory Technologists Profession Regulation, and Article 4 of the CMLTA Bylaws, which are subject to revision from time to time. To complete your application for initial for reinstatement registration and an MLT Practice Permit, you must attest to the following declarations.
Declaration Question #1
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Agree
Disagree
I understand and agree that it is a Regulated Member’s responsibility to provide the CMLTA with a valid email address and to promptly update this and all other contact information (including change of employment or employer) when changes occur.
Declaration Question #2
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Agree
Disagree
I understand and agree that the CMLTA requires a Regulated Member’s email address for the purposes of executing CMLTA operations and fulfilling its mandate pursuant to the Health Professions Act and the Medical Laboratory Technologists Profession Regulation.
Declaration Question #3
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Agree
Disagree
I understand and agree that all CMLTA emails will pertain to the regulation of the Medical Laboratory Technologist (MLT) profession and should be regarded as important CMLTA information, such as the notification of registration, annual MLT Practice Permit renewal, the Continuing Competence Program (CCP) Compliance Audit, and similar regulatory matters.
Declaration Question #4
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Agree
Disagree
I understand and agree that all CMLTA emails must be opened and responded to promptly.
Declaration Question #5
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Agree
Disagree
I consent to the CMLTA providing information to employers and prospective employers regarding my MLT registration status, MLT Practice Permit status, or both.
Declaration Question #6
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Agree
Disagree
I understand and agree that it is my professional duty and responsibility to understand and comply with the requirements of the Continuing Competence Program (CCP).
Declaration Question #7
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Agree
Disagree
I understand that all CMLTA CCP records are subject to review and I may be required to participate in a Compliance Audit and submit up to five (5) years of records or other relevant information to substantiate my Learning Plan and CCP compliance.
Declaration Question #8
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Agree
Disagree
I agree that I apply the knowledge, skills, judgments, and attitudes necessary for my current area of professional practice.
Declaration Question #9
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Agree
Disagree
I am aware that any false or misleading statements made by me or contained in documents provided by me may be grounds for referral to the Complaints Director for further investigation and may constitute unprofessional conduct under the Health Professions Act and could be the subject of a Hearing Tribunal hearing.
Declaration Question #10
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Agree
Disagree
I have not been the subject of a member undertaking, a complaint, an investigation, a hearing, or an appeal related to unprofessional conduct under Part 4 of the Health Professions Act or any other enactment that regulates a profession in Alberta or elsewhere. If disagree, please provide particulars.
Declaration Question #10 Additional Information
Declaration Question #11
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Agree
Disagree
I have not been disciplined by any regulatory body responsible for the regulation of Medical Laboratory Technologists or for another profession. If disagree, please provide particulars.
Declaration Question #11 Additional Information
Declaration Question #12
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Agree
Disagree
I have not been charged with, pleaded guilty to, or been found guilty of (i) a criminal offence or similar offence in Canada or (ii) an offence of a similar nature in a jurisdiction outside of Canada. If disagree, please provide particulars.
Declaration Question #12 Additional Information
Declaration Question #13
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Agree
Disagree
I do not have a criminal record. If disagree, please provide particulars.
Declaration Question #13 Additional Information
Declaration Question #14
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Agree
Disagree
I have not received a full or partial pardon for a criminal or similar offence in Canada or elsewhere. If disagree, please provide particulars.
Declaration Question #14
Declaration Question #15
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Agree
Disagree
I have not been the subject of an incapacity assessment, a fitness to practice assessment, or a similar assessment relating to my practice as an MLT or a healthcare provider. If disagree, please provide particulars.
Declaration Question #15
Declaration Question #16
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Agree
Disagree
I have not been refused registration or a Practice Permit under the Health Professions Act nor have I been refused registration, a Practice Permit, licensure, or certification with a professional regulatory body. If disagree, please provide particulars.
Declaration Question #16
Acknowledgment
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By clicking the submit button, I acknowledge I have read and understand the CMLTA Declarations as stated above and confirm and declare the information I have provided is accurate and complete. I am aware the information I provide will be used and disclosed as provided for under current legislation by the CMLTA in carrying out its regulatory functions.
Signature
*
Clear Signature
Administration Fee (choose one)
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Initial Application - $75.00
Reinstatement Application - $50.00
MLT Registration Dues will be paid separately once your application has been approved.
Total
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$0.00
Stripe Credit Card
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Card
Name on Card
Submit