SALPN Emergency Registration & Licensure Extension Application Form

This form is only applicable to those who have an active emergency license.

SALPN Extension Emergency Registration & Licensure Application Form
Did you obtain employment while registered with emergency licensure to assist with or support in the COVID-19 pandemic? *
Facility Name
Location
Area of Nursing
Full-time/ Part-time/ Casual
Start Date
Expected End Date
Do you have a letter of offer or documentation confirming your current employment? *
If yes, please upload the documentation here.
Maximum upload size: 268.44MB
Were you required to provide your new employer with an updated criminal record check upon hire? *
If yes, please upload a copy here
Maximum upload size: 268.44MB