ApplicationApplication FormThis form cannot be saved. If you leave this page, you will have to start from the beginning.Application FormPage 1Page 2Page 3Page 4Page 5 Long-Term Care Home Information Long-Term Care Home Name * Long-Term Care Home Address * City * Province * Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Post Code * LHIN * Waterloo Wellington North Simcoe Muskoka Mississauga Halton Erie St. Clair Toronto Central Central East Central West Hamilton Niagara Haldimand Brant North East South East South West North West Champlain Central Number of Beds * ERCC Team Member Training Package * A B C D Number of PSWs Employed (Estimated, Including Part-time, Full-time, Casual PSWs) * If you are human, leave this field blank. Next Skip back to main navigation