Cna Renewal Application - Nevada State Board Of Nursing
Download a blank fillable Cna Renewal Application - Nevada State Board Of Nursing in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Cna Renewal Application - Nevada State Board Of Nursing with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3Application for CNA Renewal
Nevada State Board of Nursing, 5011 Meadowood Mall Way, Suite 300, Reno, NV 89502-6547, Toll Free (888) 590-6726
Fax (775) 687-7707 OR (702) 486-5803
This renewal application with the $50 renewal fee must be received on or before the end of the business day on which your current certificate
expires. Nevada has no grace period—if your application is received after your certificate expires, your certificate will lapse and you may not
practice. Fees are not refundable (NRS 632.345). To practice as a nursing assistant in Nevada, you must hold an active Nevada CNA
certificate.
First Name
Last Name
Check if
new address
Address
City
State
Zip
Telephone#
CNA
CNA Certificate#
Social Security Number
Date of Birth
Email Address
If you wish to renew your certificate, please answer all questions.
It is a violation of Nevada law to falsify this application and sanctions may be imposed for fraud or misrepresentation.
Incomplete applications will be returned to you for completion and this delay may cause your certificate to lapse.
Section 1. General
Yes
No
I am subject to a court order that requires me to pay for the support of one or more children.
I am in compliance with that court order. (If you answered No to the question above, mark N/A.)
Yes
No
N/A
Yes
No
My name has changed and I have not notified the Nevada State Board of Nursing. Please attach a completed
name change form to this application. (Visit Board website or call for form.)
Section 2. Employment and Training
Yes
No
I affirm (swear) I have worked 40 hours as a CNA, within the CNA scope of practice and at the direction of a
licensed nurse (RN or LPN) during the past 24 months. Enter the name, state abbreviation and license number
of the directing RN or LPN:
Full Name
State
License #
Yes
No
I affirm (swear) I have 24 hours of in-service training (within the CNA scope of practice) in the previous two years. (You
may be selected for audit and must keep your in-service training records for four years.)
(You must indicate a date. Phrases such as TODAY,
I last practiced as a CNA on this date?
MM/DD/YY
In what state?
CURRENTLY, PRESENTLY, STILL PRACTICING, etc. will
cause a delay in processing your application.)
(continued)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Medical