Apply Now

Employer Application Form

Health institution employers can use this form to apply to participate in the CASN Residency Program or to request more information.

This field is hidden when viewing the form

Next Steps: Sync an Email Add-On

To get the most out of your form, we suggest that you sync this form with an email add-on. To learn more about your email add-on options, visit the following page: (https://www.gravityforms.com/the-8-best-email-plugins-for-wordpress-in-2020). Important: Delete this tip before you publish the form.

Name of Institution(Required)

Enter the name of the applying health institution.

Institution Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Contact Name(Required)

First Last

Contact Email(Required)

Enter Email Confirm Email

Contact Telephone

Institution profile information. Check all that apply.

Located in Northern Canada

Employs new graduates who are Indigenous or a racialized minority

Predominantly serves a linguistic minority

Classification of areas predominantly served by Institution(Required)

Large urban (>100,000)

Medium population centre (30,000-99,99)

Tree Small population centre (1,000-29,999)Surgery Services

Rural areas (all areas outside population centres)

Remote (community is located over 350 km from a service)

Type of health care services you want to consider for the Residency Program(Required)

In-patient hospital

Out-patient clinic

Ambulatory clinic

Public/Community health

Rehabilitation hospital

Long-term care facility

Primary Care

Other

When would you want to begin the program?

How many new nurses would you expect to enroll in the Residency Program?

How many preceptor-mentors would you expect to enroll in the preceptor-mentor training?

Provide any additional information about your organization or ask questions about the Residency Program

Contact us

TEL: (613) 235-3150
FAX: (613) 235-4476
E-MAIL: education@casn.ca

Tweets by @CASN43