Fingerprint Submission Form - Nevada State Board Of Nursing printable pdf download

Nevada State Board of

URSING

Instructions for Completion and Submission of Fingerprint Card

If you download an application from the Board’s website, a fingerprint card will be mailed to you upon receipt

of your application in the Board office. If you request an application by mail, a fingerprint card will be

included in that packet. You are strongly encouraged to complete your fingerprints immediately and submit

the completed form on the reverse side with the Civil Applicant Waiver OR the fingerprint card along with

the Civil Applicant Waiver at the same time as your application.

1. If you fingerprint in Nevada, you are strongly encouraged to have your fingerprints submitted via electronic

transmission (livescan) instead of submitting a fingerprint card. Electronic transmission is only available if you have

your fingerprints captured in Nevada.

2. You must submit a completed fingerprint card (Form FD-258) provided by the Nevada State Board of Nursing (the

Board);

a. Complete the information block on the card, and make sure it is legible: last, first, and middle names; signature;

residence (complete address); citizenship; date of birth; place of birth; sex; race; height; weight; eyes; hair;

and Social Security number (if you have one). You will also need to make sure that the Signature of Official

taking prints block is signed by the appropriate individual. Cards without these information blocks completed are

considered “incomplete” and will be returned to the applicant. Illegible cards cannot be processed.

b. Fingerprinting on the Board’s coded card may be done by a law enforcement agency in any state or by a private

fingerprinting service. (The Board’s website

has a list of Nevada fingerprinting

locations that offer electronic submission (livescan) as well as fingerprinting on cards.) The Board provides

fingerprint capture by appointment in its offices.

3. Complete and detach the form on the reverse side, and send the fee and completed fingerprint card to the address

below. If you have your fingerprints submitted by electronic submission, you will make payment to the agency that

captures your fingerprints, but you must send a copy of your receipt to the Board.

4. All applicants must complete the attached Civil Applicant Waiver and submit it with the form on the reverse side of

these instructions.

5. Be sure:

 You have your fingerprints captured at an in-state (NV) livescan location (recommended); OR

 A fingerprint card is completed and the card is not folded, torn or damaged in any way.

 The Information block is complete and legible

 The card is signed by the appropriate persons (applicant and official)

09/2016

 The coded card (Form FD-258) provided by the Board (or law enforcement agency) is used exclusively

 You have completed and submitted the Civil Applicant Waiver

Please note: If you have previously been fingerprinted for your place of employment or another board of nursing,

we are unable to use those results. Federal law prohibits the sharing of fingerprint information. You will need to

be fingerprinted specifically for the Nevada State Board of Nursing.

WARNING: Due to various factors, it may take up to four months for the Board to receive the official fingerprint results

from the Department of Public Safety and FBI. A permanent license/certificate will not be issued prior to receipt of both

fingerprint reports. A temporary license cannot be extended beyond the 6-month expiration date. You are urged to

fingerprint early in the application process.

Fingerprint Submission Form - Nevada State Board Of Nursing