Notice of Non-Practice

The CMLTA mandate of patient safety and public protection is reinforced with mandatory registration for all individuals employed and practicing as Medical Laboratory Technologists (MLTs). If an MLT is considering retirement, an extended leave of absence, or departing from professional practice for some other reason resulting in the non-renewal of registration and an MLT Practice Permit, it is an individual’s professional duty and responsibility to notify the CMLTA.

Name *

First

Last

CMLTA Registration # *

Email *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

Non-Practice Effective Date *

Reason for Non-Practice *

Expected Return to Work Date (if applicable)

Declarations *

I acknowledge and affirm that:

After the notice date provided above, I will not be undertaking any MLT duties of a Regulated Member of the CMLTA, including: Providing professional services directly to the public; Conducting laboratory tests that are used by other Regulated Members to provide professional services directly to the public; Teaching the practice of medical laboratory technology to Regulated Members or students of the regulated profession; and Supervising Regulated Members who provide professional services to the public.

I acknowledge and affirm that:

It is an offense pursuant to the Health Professions Act to deliberately or impliedly present myself as an MLT while not registered with the CMLTA or in possession of a valid MLT Practice Permit. *

I understand that:

Prior to returning to professional practice and before MLT employment is secured, I must contact the CMLTA to reinstate* as a practicing Regulated Member. I also understand that all outstanding Continuing Competence Program requirements must be fulfilled before consideration will be given to an application for reinstatement as a Regulated Member of the CMLTA.

Signature *

Clear Signature

* Pursuant to Section 43(1) of the Health Professions Act, if a Regulated Member does not apply for a Practice Permit, the CMLTA may cancel their registration and Practice Permit. Furthermore, pursuant to Section 45(1) an individual may apply for a Practice Permit to be reissued and registration reinstated in accordance with Bylaws. This means the applicable reinstatement requirements and fee will apply.