Community Care Licensing

Community Care Licensing

Proposed Manager Form

(New Applications only)

(Child Care)

See ‘The Guide’ to Applying for a Child Care Licence

This form must be completed and submitted to Licensing Direct when an applicant is hiring a manager

Facility Name: / Applicant Name:
Facility Address:
Service type(s):
Manager Name:

Responsibility of applicant:

It is your responsibility as the applicant to assess the suitability of your proposed manager. The purpose is to ensure that the proposed manager is of good character; has the training, experience and other qualifications required under the regulation; has the personality, ability and temperament necessary to operate a child care facility in a manner that will maintain the spirit, dignity and individuality of the children in care (Community Care and Assisted Living Act Section 11 (2)(a)(b)).

Submit to Licensing Direct three references for your Manager (i.e. copies of letters, emails, records of reference checks you have completed)

Schedule B 3 of the Child Care Licensing Regulation

Ensure Licensing Direct has Criminal Record Results for proposed manager (either a Schedule D or shared results of a previously completed check done through the Ministry of Justice)

Provide a statement of the duties, qualifications, relevant work experience, and suitability of the proposed manager -Schedule B 5 (a) of the Child Care Licensing Regulation.

Provide a statement which outlines how the requirements of Schedule B 5 (a) are met:

Retain on site the following documents as per Section 19 (character and skill requirements) of the Child Care Licensing Regulation. A Licensing Officer will review these documents during the initial inspection. Submit this form only. DO NOT submit the documentation below to Licensing Direct.

Check the boxes below to indicate information has been obtained:

A record of the person’s work history

Confirmation that the proposed manager is physically and psychologically capable of working with children and carrying out assigned duties in a community care facility – (Medical Practitioner Form (Child Care) – HP-CF-9034)

Copies of diplomas, certificates or other evidence of the person’s training and skills

Evidence that the person has complied with the province’s immunization and tuberculosis control programs – (Immunization

and Tuberculosis Control Form (Child Care) - HP-CF-9035)

By submitting this form, I confirm that the appointed manager meets the criteria listed above and is delegated full authority to operate the Community Care Facility in accordance with the Community Care and Assisted Living Act and the Child Care Licensing Regulation.

Applicant Signature Date: dd/mm/yyyy

HP-CF-9039 February 2016 Page 1 of 1