Request for Issuance of a Provisional Teaching Authorization
Transcription
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 page 1 de 2 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 page 2 de 2