Get Wy Nha Application For Licensure 2006-2025

Filling out the Wyoming Nursing Home Administrators Application for Licensure online can be a straightforward process when guided correctly. This comprehensive guide will help users navigate each section ensuring accurate and complete submissions.

Follow the steps to fill out the application effectively.

1. Click the ‘Get Form’ button to access the application form and open it for editing.
2. Begin by choosing your desired licensure type, either 'Temporary' or 'Regular Full Licensure.' This selection is crucial as it dictates the pathway for your licensure.
3. Enter your full name in the designated fields. Make sure to include your last, first, and any previous names used.
4. Provide your Social Security number in the specified section to ensure proper identification.
5. Fill out your residence details, including street address, city, state, and ZIP code. Additionally, include your telephone number.
6. If applicable, provide your employer's information including address and contact number. Repeat this for any Wyoming employer if different from the above.
7. Indicate your preferred address for correspondence by checking the appropriate box for residence, employer, or Wyoming employer.
8. Confirm your U.S. citizenship status by selecting 'Yes' or 'No.' Also, include your birth date and place of birth.
9. Detail any licenses held in other states including the type, number, issue date, expiration date, and current status. This information must be accurate and reflect your professional history.
10. List all education institutions attended, beginning with the institution from which your highest degree was obtained. Provide addresses, dates attended, and degrees earned.
11. Provide names and contact information for two references who are not related to you. They should submit letters of reference directly to the board.
12. Document your employment history for the past five years, starting with your most recent employer and including responsibilities.
13. Respond to the questions regarding application rejections, license restrictions, and any previous criminal convictions. Attach a separate sheet if necessary for explanations.
14. Attach a current photograph where indicated in the application.
15. Complete the affidavit section by signing and dating the application, confirming that all provided information is true to the best of your knowledge.
16. Once all sections are completed, save your changes, and you will have the option to download, print, or share the completed application.

Encourage others to complete their WY NHA Application for Licensure online using this guide for a smooth process.