Cna Renewal Application - Nevada State Board Of Nursing Page 3
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1
2
3Affirmation. All Applicants Must Complete
I affirm (swear) that I have read this application and the statements made are true and correct.
Signature
Date
The renewal fee is $50. You may pay by credit card
Before submitting your application please make sure you have answered
(MasterCard, Visa, Discover, American Express), personal
ALL the questions in the top portion and Sections 1 through 3 and:
or cashier’s check, or money order, made payable to the
have included all required documentation
Nevada State Board of Nursing (NSBN). Remit U.S. Funds
only.
have included the correct fee ($50)
Please note: If you do not submit all required fees, your
have included your current mailing address
application will be returned to you, unprocessed.
have submitted fingerprints, if required by the Board
If Paying By Credit Card, Please Complete
Visa
MasterCard
Discover
American Express
Card number
Exp. date
Name on card
Amount
Signature
$50.00
Helpful information about renewal requirements
Proof of 24 hours of continuing training or in-service related to Nursing Assistant Skills.
All continuing training/inservice courses must be within the CNA scope of practice. You may be selected for audit and
must keep copies of your inservice training records for four years.
The 24 hours of continuing training/in-service courses and the 40 hours of employment must be within the previous
two years.
For example, if your certificate expires on 9/30/14, you must submit proof of employment and training which took place
between 9/30/12 and 9/30/14.
Proof of 40 hours of employment as a CNA under the direction of a licensed nurse.
Your 40 hours of employment must be as a CNA and in the Board-authorized scope of practice as a CNA. A Board
advisory opinion states that a person who is certified as a nursing assistant in Nevada, is working under a title other
than CNA, and is performing duties other than those identified in the CNA model curriculum, is not practicing as a
CNA
.
You must enter the full name, state, and license number of the nurse who is verifying that you worked 40 hours in the
scope of a CNA in the previous two years. The Board conducts random audits of these employment verifications.
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