This form is an application for compensation benefits for hearing loss.
If applying for hearing loss which occurred over time, a record of your employment history is needed. You can get this by completing and mailing this 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.
If applying for acute/traumatic hearing loss, the employment history is not needed; only the current employment information is required, which is asked in the next section.