This form is an application for compensation benefits for hearing loss.
If your hearing loss occurred over time, a record of employment history is needed to verify that your Yukon employment history meets the criteria in the policy. Please complete and mail the "Request Template” found at this link: Request to Service Canada for Employment History.
Please note, it can take up to 4 months for Service Canada to return your employment history. In order to avoid any further delays in your claim, please submit your employment history to the board, as soon as you receive it.