Form 08-4186 - Instructor Reference Information - Alaska Nurse Aide Registry

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NURSE AIDE REGISTRY
Instructor Reference Information
The nurse aide named below has applied for certification to the Alaska Nurse Aide
Registry.
(Name of Nurse Aide)
He/She has successfully completed the competency evaluation. Do you have
problems with his/her performance, work habits, or professional conduct?
YES
NO
Comments:
Verified by
Date
(Name)
(Title/Position)
08-4186 (Rev. 01/97)

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