SALPN Emergency Registration & Licensure Extension Application Form SALPN Emergency Registration & Licensure Extension Application Form First Name: * Last Name: * Registration Number: * Click here to look up your Registration Number Did you obtain employment while registered with emergency licensure to assist with or support in the COVID-19 pandemic? * Yes No If yes, please indicate where you are employed. * Facility Name * Location * Area of Nursing * Full-Time Part-time Casual Full-time/ Part-time/ Casual * Start Date * Expected End Date Do you have a letter of offer or documentation confirming your current employment? * Yes No If yes, please upload the documentation here. Drop a file here or click to upload Choose File Maximum upload size: 268.44MB Were you required to provide your new employer with an updated criminal record check upon hire? * Yes No Non Applicable If yes, please upload a copy here Drop a file here or click to upload Choose File Maximum upload size: 268.44MB If you are human, leave this field blank. Submit