Report Your Termination or SuspensionReporting a Termination or Suspension Employer/Manager Name: * Employer/Manager Phone Number: * Employer/Manager Email Address: * Facility/Workplace: * LPN Name: * LPN Registration Number: * Click here to find the LPN Registration Number Was the LPN terminated or suspended? * Select from dropdown Suspended Terminated Date the LPN started employment: * Date the LPN was terminated or suspended: * Reason for termination or suspension: * Select from dropdown Professional Incompetence Professional Misconduct Please upload a Letter of Termination, if applicable. Drop a file here or click to upload Choose File Maximum upload size: 268.44MBDid you, or do you plan to submit a complaint to the SALPN about the LPN’s practice? * Yes No Unsure If you are human, leave this field blank. Submit