Request for Issuance of a Provisional Teaching Authorization

Request for Issuance of a Provisional
Teaching Authorization
Vocational Training
Ministère file number :
A- Identifty of candidate
 Mr
Last name (at birth)
First name
 Mrs.
Status
 Canadian citizen
 Permanent resident
 Work permit  Other_________
Date of birth (yyyy-mm-dd)
Social insurance number
Permanent code
Training program pertinent to this request (DCS, DVS,
Bachelor’s Degree)
The training pertinent to this request was received in :
 French
Address
 English
 Other____________
Apartment
City
Province
Postal code
Telephone (Home)
Other numbers (Cell, Work)
E-mail address
B- Assignment and reason for the request - Section to be completed by the employer (section 8 of the
Regulation respecting teaching licences)
Sector
School Year
DVS Program To Be Taught
Promise of Employment
By virtue of this request for a provisional teaching authorization, we __________________________________________________
(name
of
employer,
school
board
or
private
educational
institution)
whose
head
office
is
located
at
_________________________________________________ (address of employer) hereby declare that we intend, within the next
12 months, to hire the abovementioned candidate to teach a vocational training subject directly related to his/her training and that this
job cannot be filled by the holder of a teaching licence.
The teaching load represents ___________________ % of the task, carried out on a  full-time or a  part-time basis.
Signature
EMPLOYER’S
SEAL OR STAMP
Name in block letters
Date
Position
Telephone
Extension
C- Supporting documents that the candidate must attach (section 40 of the Regulation respecting
teaching licences)





Certified copy of the birth record, birth certificate or valid passport. 
Certified copies of the transcript and diploma related to the
program to be taught (Diploma of Vocational Studies, Diploma of
College Studies or Bachelor’s degree).
Certified copy of the attestation of 3 000 hours of experience
related to the program to be taught.
Certified copy of the candidate’s certificate of Canadian
citizenship, permanent resident document, work permit or
Québec certificate of acceptance authorizing the
candidate to work in Québec (if the candidate was born
outside Canada).
Certified copy of the university transcript attesting that the 
candidate has earned at least 3 credits in introduction to teaching
in the Bachelor of Education in vocational training.
If the candidate studied outside Canada, a certified copy of the
comparative evaluation of studies done outside Québec by the
Ministère de l’Immigration, de la Diversité et de l’Inclusion.
Declaration Concerning a Judicial Record (section 25.1 of
the Education Act) available on the Ministère Web site.
If certified copies cannot be provided and the candidate presents valid reasons why, the Ministère may, exceptionally, accept sworn
copies.
The personal information collected by the Ministère is essential to the exercise of its functions, as provided for under the Regulation
respecting teaching licences. This information may also be used for research or statistical purposes. It is treated confidentially and is
accessible only to authorized staff who need it to carry out their duties. You have the right to request access to your personal information
held by the Ministère and to request that it be corrected. To exercise this right, please contact the person responsible for access to
documents and the protection of personal information.
I hereby request that a temporary teaching authorization for vocational training be issued in my name.
Signature
Ministère de l’Éducation, de l’Enseignement supérieur et de la Recherche
Date
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D- Reserved for the Ministère

Émission de l’autorisation provisoire d’enseigner en formation professionnelle
 Programme de baccalauréat de 120 unités

Refus signifié à la candidate ou au candidat qui ne satisfait pas aux exigences minimales relatives
 À la formation à l’enseignement  À la formation disciplinaire  À l’expérience en milieu de travail
 À la promesse d’engagement
DÉCISION
Commentaires :
______________________________________________________________________________________________
______________________________________________________________________________________________
Secteur en formation professionnelle
La formation à l’enseignement à l’appui de la
demande a été reçue en :
 Français
 Anglais
Signature de la personne autorisée
N° du document
Date du dernier document reçu
Date
Initiales
Date d’émission
Send your request to :
Direction de la formation et de la titularisation du personnel scolaire
Ministère de l’Éducation, de l’Enseignement supérieur et de la Recherche
1035, rue De La Chevrotière, suite 600
Québec (Québec) G1R 5A5
Ministère de l’Éducation, de l’Enseignement supérieur et de la Recherche
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