Sample Nomination Form

CRTO Election Professional Member Nomination Application

Please complete all sections (1-6) of the Election Nomination Application and submit it to the CRTO. You will receive a confirmation after your eligibility has been verified.

In general, to be eligible for election you must be a Member-in-good-standing of the CRTO (i.e., not in default of payment for any fees or the subject of a discipline or incapacity proceeding) and hold a current General or Limited certificate of registration. Full eligibility criteria can be found in Article 16 of the CRTO By-Law.

You can only run for one position in your voting district. If you are unsure of which electoral district you’re in or your eligibility to run for election, contact Carole Hamp, Registrar & CEO at hamp@crto.on.ca or 416-591-7800 x.21.

Whether you are a Council or Non-Council Committee Member, you have a general responsibility to become familiar with the objects of the CRTO, as well as relevant legislation and policies. Council/Non-Council Committee Members are expected to prepare themselves for meetings by reading the materials that are pre-circulated and participate actively in the deliberations and decisions. Depending on the committee, you may participate in the development, establishment and maintenance of policies, standards and regulations. Committees such as Registration, Quality Assurance, Complaints and Discipline break into panels to consider specific referrals regarding member practices.

For detailed information about the Election Process please see our website here.

Step 1 – Candidate Details

To provide Members in your district with information about you and your reason(s) for seeking election as a CRTO Council or Non-Council Committee Member, you are required to complete the candidate statement. Please note that a copy of your candidate statement will be provided to all eligible CRTO voters in your district.

To provide the Executive Committee with information about you and your reason(s) for seeking appointment as a CRTO Non-Council Committee Member, you are required to complete the candidate statement.

Name:   

Electoral District Number:   

I am seeking election as a:   

Background / Statements

NOTE: You may wish to use a text editor (i.e., Word, Notepad, etc.) to write your statements then copy into the fields below to prevent the system from timing out and possibly losing your information.

Relevant skills and experience (e.g., committees, working groups, volunteer work, etc.):


Reason(s) for seeking a seat in the CRTO election:


In your opinion, what are the key issues facing the profession today, as they relate to the public interest?

Upload My Picture(s):


Step 2 – Self Declaration

I confirm that:

I reside or practice in the jurisdiction in which I am running for election
I hold a current General or Limited certificate of registration with the CRTO
I have the personal commitment and availability to serve effectively during my elected term 
I am not running for election in any other electoral district
I am not in default of the payment of any fees
I am not the subject of any current disciplinary or incapacity proceeding
I hold a certificate of registration that is not subject to a term, condition or limitation arising from a professional misconduct, incompetence, incapacity or quality assurance proceeding 
I have not, within the previous 12 months, been an employee, director, officer or elected member of a professional association (e.g. CSRT, RTSO) or special interest group related to the profession. An “Elected Member” in a professional association would be a position on their executive/board.
I have not, within the previous 12 months, been an employee, director, officer, or elected member of a working group or committee of an organization which develops or produces “entry to practice” examinations related to the profession
I have not, within the previous 3 years, been disqualified from sitting as a CRTO Council or Committee member
I have not, within the previous 6 years, had my certificate of registration suspended or revoked as a result of a professional misconduct, incompetence or incapacity proceeding
I do not have any criminal charges or convictions pending or found against me that would bring the CRTO or the regulatory sector into disrepute
I do not have a social media presence that could bring the CRTO or the regulatory sector into disrepute

 


Step 3 – Competency and Experience Questionnaire

For the following competencies or areas of ability, please rate yourself and provide examples to support your rating.

  1. I have the ability to participate in a collaborative decision-making structure (such as having served on other Boards, committees, etc.).

    Self-Rating: 1 (limited experience) – 5 (extensive experience, have led these bodies)

    Please provide details:


  2. I have experience in being objective, rational and analytical when addressing an issue or making a decision

    Self-Rating: 1 (little experience) – 5 (extensive experience)
     

    Please provide details:


  3. I have an awareness and understanding of the social issues facing us today

    Self-Rating: 1 (not very aware) – 5 (very aware)
     

    Please provide details:


  4. I have a fundamental understanding of what the public interest is and how that relates to the role I would hold at the CRTO, if elected.

    Self-Rating: 1 (I think I understand) – 5 (I can explain it clearly to someone else)
     

    Please provide details:


  5. I am an effective communicator.

    Self-Rating: 1 (limited experience in communicating) – 5 (extensive experience in communicating)


    Please provide details:

Step 4 – Nominee’s Consent and Statement of Accuracy

I consent to allow my name to stand for election and hereby declare that:

  1. I have read and understood the position description and specific responsibilities of being a CRTO Council Member or a Non-Council Committee Member (including Confidentiality and Code of Conduct requirements); and
  2. Based on the CRTO’s eligibility criteria, I am eligible to stand for election.

Date:


Step 5 – Nominators

The following Members of the College of Respiratory Therapists of Ontario, are eligible to vote in Electoral District #  and are nominating  

My three (3) nominators are as follows:

1.  Name:  
  CRTO Register #   
  District #   
     
2.   Name:
  CRTO Register #
  District #
     
3. Name:
  CRTO Register #
  District #

Note: Nominators must be eligible to vote in the same District as the nominees are able to vote.


Step 6 – Record of Affiliation

To assist the CRTO with identifying any potential conflict of interest, please use this form to outline all of the affiliations and/or memberships you have including those related to employment and voluntary activities. Please be as thorough as possible.