120 Forms found for example-of-a-medical-license-number

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  • 0214
    Lieutenant Governor's Community Volunteer Award for Students

    The Lieutenant Governor's Community Volunteer Award for Students pays tribute to students who not only complete the required number of volunteer hours to graduate, but who go above and beyond. Each year, an award is given to one graduating student at each of Ontario's secondary schools.
  • on00753
    Letter of Consent – Secondary Trapping Licence (Youth)

    Applicants applying for a secondary trapping licence for youth must submit a completed Letter of Consent – Secondary Trapping Licence (Youth) for a new licence or renewal. This form collects signed parental/guardian consent and signed mentor trapper consent and mentor trapper licence number.
  • 4611-45
    Paramedic Labour Mobility Application

    Application and Verification forms for the Ministry of Health (MOH) Paramedic Labour Mobility Equivalency for Paramedics who hold a valid license or certification in good standing from other Canadian provinces or territories and wish to obtain equivalency in Ontario for their paramedic qualification.
  • on00559
    Telescopic Lens Renewal

    This form is used exclusively for the Ministry of Transportation’s Telescopic Lens Program to obtain regular updates to ensure participants continue to meet licensing requirements.
  • 014-4580-64
    Notice of Adverse Test Results and Issue Resolution

    The Notice of Adverse Test Results and Issue Resolution form is to be used by licensed laboratories and owners/operators of small drinking water systems to support required written notifications pertaining to small drinking water system adverse water quality incidents (AWQI).
  • 014-4578-64
    Laboratory Services Notification (LSN)

    The Laboratory Services Notification (LSN) form is to be used by small drinking water system owners/operators to notify the local public health unit in writing as to which licensed laboratories will test drinking water samples for their small drinking water systems.
  • 012-1987
    Well Contractor Licence Application - Form 1

    This form is for individuals/businesses interested in applying for a new Well Contractor Licence, which is required by anyone engaging in the business of well construction, and expires on March 31 each year following the year of issue. Ontario Regulation 903 under the Ontario Water Resources Act prescribes the licensing requirements and outlines the roles and responsibilities for individuals/businesses and activities associated with wells.
  • 012-1993
    Well Technician Licence Application - Form 4

    This form is for individuals interested in applying for a new Well Technician Licence or to add-a-class(es) to their existing Well Technician Licence, The licence is required to work at the construction of wells and expires on March 31 following the year of issue. Ontario Regulation 903 under the Ontario Water Resources Act prescribes the licensing requirements and outlines the roles and responsibilities for individuals/businesses and activities associated with wells.
  • on00195
    Application for a New Licence for the Operation of a Dairy Plant The Milk Act (R.S.O. 1990, c.M12), and Regulations 761

    A new licence is required prior to beginning the operations of a dairy plant including: When a facility is being licensed for the first time. When an existing licensed plant is transferred to a new owner (transfer of ownership) An "Application for a Permit to Construct or Alter a Building Intended for Use as a Dairy Plant – For New Applicants" must be submitted at the same time as an “Application for a Licence for the Operation of a Plant”. Note, the licence will not be issued until the plant is complete and the Ontario Ministry of Agriculture, Food and Rural Affairs (OMAFRA) has confirmed, through inspection, that it meets all applicable regulations under the Milk Act (Ontario).
  • on00520
    Relocation Application (Fixed Site)

    Licensees of Integrated Community Health Services Centres (ICHSCs) must submit an application and obtain written approval from the Director of Integrated Community Health Services Centres prior to a centre’s relocation. For the purposes of this application, a “Fixed Site” centre is a licensed ICHSC where the Limitations and Conditions of the licence specify a single geographic location or address where specified services may be provided.
  • on00350
    Special Sales Licence Application Livestock Community Sales Act

    A licence is required to carry out the community sales of consigned livestock in Ontario. This applies to an operator licensed for Class 1 or Class 2 community sales to hold an extra community sale not authorized by the licence for Class 1 or Class 2 community sales.
  • 012-1995
    Application for Assistant Well Technician Identification Card - Form 8

    This form is for licensed well contractors and their assistant technicians (not sooner than after four months of employment with the well contractor) interested in applying for or renewing an Assistant Well Technician Identification Card, which expires 36 months following the date of issue. Ontario Regulation 903 prescribes the licensing requirements and outlines the roles and responsibilities for individuals/businesses and activities associated with wells.
  • 013-3445
    Application for Refund - Bad Debt (BDT)

    Used by beer vendors in Ontario (e.g., licensed establishments) who paid amounts on account of the beer tax on beer made by Ontario beer manufacturers that was sold to a purchaser but for which payment has not been received and the sale has become uncollectible. This does not apply to purchases from or through the Liquor Control Board of Ontario.
  • 003-atdia-003
    Notice of Transfer of a Machine

    When a tile drainage machine changes ownership, the Regulations under the Agricultural Tile Drainage Installation Act requires that a notice of transfer of a machine must be completed and submitted within ten days after the transfer occurs. Where the machine is already licensed, this licence will be transferred to the new owner.
  • on00579
    Authorization and Consent Form

    he purpose of this form is to collect necessary information to obtain authorized consent and assure identity, under the Freedom of Information and Protection of Privacy Act (FIPPA), for application of services delivered by the Ministry of Health on your behalf (or for a “Health Care Group” in which you are a registered member), including: • Application for an OHIP Billing Number • Changes to Health Care Group Registration Information
  • 014-5048-45
    AEMCA Examination Application

    The application form is for candidates who have either successfully completed the Paramedic training program provided by an approved College or Training Institution or have been considered equivalent through the MOH Standard Paramedic Equivalency Process and wish to write to write the Ministry of Health (MOH) Advanced Emergency Medical Care Assistant (AEMCA) examination.
  • 014-4900-85
    Physician Affiliation Authorization and Declaration of Professional Standing for ICHSCs

    The form is used to confirm a physician's qualifications to provide the requested services prior to processing a request to affiliate to a particular ICHSC. The licensee must ensure that the physician has been affiliated to the centre before they begin to provide licensed services.
  • on00722
    Application to Surrender an Aggregate Licence or Aggregate Permit under the Aggregate Resources Act

    The Aggregate Resources Act (ARA) provides for the transfer of a licence or permit. A transferred licence or permit will allow the continued operation of the licensed or permitted site under the same terms, conditions and site plan requirements as the original licence or permit. Any changes or amendments to the site plan or licence/permit conditions are a separate process.
  • on00581
    Voluntary Surrender of a Meat Plant Licence

    A licensee of a provincially licensed meat plant may voluntarily surrender their meat plant licence if they no longer conduct regulated activities.