Back Up CI Contracts - Lawrence S. Bloomberg Faculty of Nursing

Back Up CI Contracts

Please note that backup CI coverage cannot occur unless all required documents are completed and returned to the Faculty of Nursing as well as full clearance has been given to work on site by the hospital/agency.
You will not be able to continue with your submission. Please contact Kong Ng at kong.ng@utoronto.ca to discuss your options.
Name

First NameLast Name
Personal Information Statement - It is a University of Toronto requirement to get consent for data collection on electronic forms.**

NoYes, I agree
Years of Nursing Experience**
Please enter a number from 0 to 99.
It is a requirement for Clinical Instructors to possess a minimum BScN education. Unfortunately we will not be able to consider candidates without a BScN degree.
BScN (Y/N)**

YN
Master’s Degree (Y/N)**

YN
CNO Registration Number*
Email

Confirmation Emailexample@example.com
Phone Number*
Mailing address street name and number*
Mailing address city and province*
Mailing address postal code*
Current Workplace and Unit*
Other locations where you can provide backup
e.g. previous employer (agency name and unit)
Area of Clinical Expertise**
If known, indicate the date of the first day working as a backup CI.

MonthDayYear
Date
Are you currently enrolled at UofT as an MN/Post-Master’s NP or PhD student?**

YesNo
Returning Clinical Instructor**

YesNo
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