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How do I fill this out?
To fill out this application, ensure you meet the eligibility requirements. Provide all requested personal information accurately. Submit all pages along with any required supporting documentation.
How to fill out the Nurse Aide I Registry Reciprocity Application?
1
Determine your eligibility based on the criteria provided.
2
Complete all sections of the application legibly.
3
Submit any required supporting documents.
4
Return the application via mail or fax.
5
Do not submit multiple applications unless instructed.
Who needs the Nurse Aide I Registry Reciprocity Application?
1
Individuals seeking to transfer their Nurse Aide I status from another state.
2
Nurse aides who wish to maintain regulatory compliance in North Carolina.
3
Healthcare facilities needing qualified Nurse Aide I personnel.
4
State regulators verifying the qualifications of Nurse Aides.
5
Military spouses looking for job opportunities in the healthcare field.
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What are the instructions for submitting this form?
To submit this application, complete all sections thoroughly and ensure all documents are attached. Send the finished application by fax to 919-733-9764 or mail it to 2709 Mail Service Center, Raleigh, NC 27699-2709. Double-check to avoid incomplete submissions and retain a copy for your records.
What are the important dates for this form in 2024 and 2025?
Applications should be submitted in a timely manner, especially to meet any regulatory deadlines set by DHSR in 2024 and 2025. Specific dates will vary, so it is essential to check for updates directly from DHSR.
What is the purpose of this form?
The purpose of this form is to facilitate the application process for individuals wishing to be listed on the North Carolina Nurse Aide I Registry through reciprocity. It outlines the eligibility criteria, personal information required, and guidelines for submission. Ensuring accurate completion is essential for timely processing by the Department of Health Services Regulation.
Tell me about this form and its components and fields line-by-line.
- 1. First Name: Your legal first name.
- 2. Middle Name: Your legal middle name, if applicable.
- 3. Last Name: Your legal last name.
- 4. Prior Name(s): Any previous names you have used.
- 5. Gender: Your gender identity.
- 6. Social Security Number: Your complete 9-digit Social Security Number.
- 7. Email Address: Your current and active email address.
- 8. Telephone Number: Your contact number with area code.
- 9. Date of Birth: Your birth date in mm/dd/yyyy format.
- 10. Mother's Maiden Last Name: Your mother's maiden last name.
- 11. Military Service Status: Indicate if you served in the military.
- 12. Military Occupational Specialty: Indicate if you performed nursing tasks.
- 13. Current Mailing Address: Your permanent address.
What happens if I fail to submit this form?
If you fail to submit this form, you will not be considered for reciprocity on the North Carolina Nurse Aide I Registry. Incomplete applications may lead to application delays or denials.
- Incomplete Application: Applications missing sections will not be processed.
- Verification Issues: Failure to provide necessary identification may result in denial.
- Non-compliance with Eligibility Criteria: Not meeting the outlined criteria can lead to application rejection.
How do I know when to use this form?
- 1. Transferring License: For nurse aides from out-of-state who wish to transfer their certification.
- 2. Maintaining Compliance: To ensure regulatory compliance to work in North Carolina healthcare.
- 3. Employment Verification: Required for job applications to demonstrate qualifications.
Frequently Asked Question
What is the purpose of this application?
This application allows qualified individuals to apply for reciprocity to be listed on the North Carolina Nurse Aide I Registry.
How do I determine my eligibility?
Review the eligibility requirements listed in Part 1 of the application.
Can I submit more than one application?
No, do not submit multiple applications unless specifically instructed by DHSR.
What if my name doesn't match the documents?
You must provide documentation verifying any name changes.
Is there a deadline for submission?
DHSR has 10 business days from receipt to review applications.
What should I do if my application is incomplete?
Incomplete applications will not be processed; ensure all sections are filled out.
How do I know if my application is accepted?
You will be notified by DHSR regarding the status of your application.
Are there fees associated with this application?
This information is not provided; check with DHSR for any applicable fees.
How can I contact DHSR for questions?
You can reach DHSR by phone at 919-855-3969.
What are the next steps after submission?
Await confirmation and further instructions from DHSR regarding your application status.
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