Submit the completed application along with the Payment Form and any additional documents to Prometric, ATTN: FL Nurse Aide Program, 7941 Corporate Drive, Nottingham, MD 21236. For online submissions, use the provided Prometric website forms. Include your email address for processing updates. Our advice is to double-check all documents and information for accuracy and completeness before submission to avoid any delays.

Check for important dates such as application submission deadlines and examination dates for 2024 and 2025 on the Prometric website.

The purpose of this form is to apply for the Florida Certified Nursing Assistant (CNA) Examination and provide necessary details for processing. It gathers personal, contact, legal history, and other relevant information needed for eligibility and scheduling of the CNA exam. Completing this form accurately and submitting required documentation ensures a smooth application process and timely scheduling of the examination.

• 1. First Name: Your first name as per your government-issued ID.
• 2. Middle Initial: Your middle initial, if any.
• 3. Last Name: Your last name as per your government-issued ID.
• 4. Date of Birth: Your birth date in MM/DD/YYYY format.
• 5. Previous Name: Provide any previous names if applicable.
• 6. Street Address: Your current street address including Apt. number or P.O. Box if any.
• 7. City: The city you reside in.
• 8. State: The state you reside in.
• 9. ZIP Code: Your postal ZIP code.
• 10. Phone Number: Your contact phone number including the area code.
• 11. Email Address: Your email address, mandatory for processing the application.
• 12. Race: Optional field to indicate your race.
• 13. Gender: Choose your gender: Male or Female.
• 14. High School Diploma: Indicate whether you have a High School Diploma or equivalent.
• 15. Criminal History: Answer the mandatory criminal and Medicaid/Medicare fraud questions.
• 16. Disciplinary History: Provide information on any disciplinary action taken against your certification.

If you fail to submit this form correctly, your application for the CNA exam may not be processed.

• Incomplete Submission: Missing information may lead to rejection or delays in processing.
• Name Mismatch: The provided name must match your government ID to avoid exam disqualification.
• Inaccurate Information: Inaccurate or false information can result in application denial or legal consequences.

• 1. New Applicants: First-time candidates for the CNA exam.
• 2. Name Change: Candidates who have had a legal name change.
• 3. ADA Accommodations: Applicants requesting testing accommodations under ADA.
• 4. Previous Examinees: Individuals who have previously taken the CNA exam since 2002.
• 5. Disclosure of History: Candidates required to provide criminal or disciplinary history.