Confirmation of Language Proficiency

Confirmation of Language Proficiency
College of Nurses of Ontario Telephone: 416 928-0900

101 Davenport Rd., Toronto, ON M5R 3P1 Toll-free (Canada): 1 800 387-5526
www.cno.org Fax: 416 928-6507 E-mail: enp@cnomail.org
Please review CNO’s Privacy Policy to understand how your personal information will be used.
Section A: Instructions to Applicant

This form is to be completed and returned to CNO by only one regulated health care professional (RHP)1 who has
worked directly with you in a health care or health care support service setting in Canada in the last two years. The
RHP must have observed you interacting with patients, clients, and/or health care professionals. If required, CNO
may request additional information about your ability to read, write, listen or speak in English or French.
SECTION 1: APPLICANT INFORMATION
First Name Last Name
CNO Application ID Category of application (RN, RPN, NP)
Date of Birth (yyyy-mm-dd)
SECTION 2: INSTRUCTIONS FOR REGULATED HEALTH CARE PROFESSIONAL IN CANADA

As the RHP completing this form, you are attesting to the following:
1. You have sufficient knowledge of and have observed the applicant’s use of their reading, writing, listening,
and speaking skills in moderately demanding and demanding situations during their interactions with patients,
clients, and/or healthcare professionals while providing services in Canada.
2. You have formed the opinion that the applicant can communicate and comprehend effectively in English or
French at a level required for safe and competent nursing practice in Ontario.
To complete this form, expertise in language assessment is not expected. Your responses are to be based solely on
your observations of the applicant’s ability to read, write, listen, and speak in English or French within the health care
or practice setting. Once CNO receives this form, it will become part of the application and may be disclosed to the
applicant during the registration process.
For this form to be valid, you must complete, sign and submit this form directly to CNO using the email address
or fax at the top of this form.
First Name Last Name
Registration Number Type of Health Care Professional
Name of Regulatory Body Province/Territory
Telephone Number Work e-mail address

MARCH 2023
1
Regulated health professional refers to a professional who is registered and practicing their profession, regulated under the Regulated Health Professions Act, 1991 in Ontario, or regulated
2023-14
in another Canadian jurisdiction under equivalent health professional legislation (for example, the Health Professions Act in B.C. or the Regulated Health Professions Act in Manitoba).
College of Nurses of Ontario © Confirmation of Language Proficiency 1

Applicant Name: ____________________________________ Application Number: ______________________________
1. In which health care setting(s) did you work with the applicant?
2. Name the organization in which you worked with the applicant in Canada.
3. What was the applicant’s position title?
4. When did you last work with the applicant? (please include year, month, day)
5. In which language is the applicant demonstrating proficiency?
English French Other ________________________
READING
The following are examples of where reading and comprehension may be observed:
reading policies, regulations, standards, etc.
reading written instructions by another health care provider
reading written instructions by a supervisor or instructor
reading charts, tables or schedules
reading shift reports left by coworkers
reading patient/client records or patient/client health information
reading information the applicant researched
Please choose one:
The applicant has the ability to read English or French.

The applicant does not have the ability to read English or French.
MARCH 2023
2023-14

Applicant Name: ____________________________________ Application Number: ______________________________
SPEAKING
The following are examples of where speaking skills may be observed:
communicating with others to solve problems
responding to the instructions of a colleague, supervisor or instructor clearly and in a way that demonstrates
comprehension
speaking to and responding to patient/client requests or needs in a way that patients/clients understand
speaking using different means of technology (phone, webinar, other electronic mediums)
Please choose one:
The applicant has the ability to speak English or French.

The applicant does not have the ability to speak English or French.
WRITING
The following are examples of where writing skills may be observed:
noting instructions or comments in a patient’s/client’s file, chart or e-health record
documenting information in a way that can be understood and used by others
preparing reports or multi-page documents in a way that can be understood by others
completing forms
taking notes during a conversation, presentation, etc.
Please choose one:
The applicant has the ability to write in English or French.

The applicant does not have ability to write in English or French.
LISTENING AND UNDERSTANDING

The following are examples of where listening skills may be observed:
listening to multi-step, complex directions from another health care provider and appropriately carrying them out
listening to requests from patients or clients and appropriately carry them out
listening and applying health care specific terminology or language appropriately
Please choose one:
The applicant has the ability to listen in English or French.

The applicant does not have the ability to listen in English or French.
Signature: ____________________________________ Date: ______________________________

(yyyy-mm-dd)
MARCH 2023
2023-14

Confirmation of Language Proficiency

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Confirmation of Language Proficiency

College of Nurses of Ontario Telephone: 416 928-0900

Section A: Instructions to Applicant

SECTION 1: APPLICANT INFORMATION

First Name Last Name

CNO Application ID Category of application (RN, RPN, NP)

Date of Birth (yyyy-mm-dd)

SECTION 2: INSTRUCTIONS FOR REGULATED HEALTH CARE PROFESSIONAL IN CANADA

First Name Last Name

Registration Number Type of Health Care Professional

Name of Regulatory Body Province/Territory

Telephone Number Work e-mail address

College of Nurses of Ontario © Confirmation of Language Proficiency 1

Applicant Name: ____________________________________ Application Number: ______________________________

3. What was the applicant’s position title?

5. In which language is the applicant demonstrating proficiency?

English French Other ________________________

The applicant has the ability to read English or French.

College of Nurses of Ontario © Confirmation of Language Proficiency 2

Applicant Name: ____________________________________ Application Number: ______________________________

The applicant has the ability to speak English or French.

The applicant has the ability to write in English or French.

LISTENING AND UNDERSTANDING

The applicant has the ability to listen in English or French.

Signature: ____________________________________ Date: ______________________________

College of Nurses of Ontario © Confirmation of Language Proficiency 3

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