Community Commitment Program for Nurses (CCPN) - Expression of Interest Form

Questions marked with * are required.

Name and Contact	Salutation: First Name: Last Name: Email Address: Telephone: City: Province: Postal Code: Preferred Language of Contact:
Current Status	*Please select the option that best describes your current situation: If other, please describe: CNO Registration Number (if applicable): CNO Registration Category:
Nursing Education	Most Recent Program/Education Category: Graduation Date (actual or anticipated): Month: Day: Year: *Name of School:
Nursing Experience	Last date of nursing practice (if applicable): Month: Day: Year: Previous employer name (if applicable): Previous employer location (if applicable):
Additional Information	Have you worked as a nurse (RN, RPN, or NP) in Ontario in the last six months (26 weeks)? Are you available for full-time employment? *Are you allowed to work in Canada without restrictions (e.g. Citizen or permanent resident, or work permit)? Is there any additional information you would like to provide?

By completing the expression of interest form you agree to receive email correspondence from Ontario Health related to job opportunities.