Get Application For Nursing Home Administrator License - State Of New ... - State Nj

This guide provides a clear and supportive approach to completing the Application For Nursing Home Administrator License for the State of New Jersey online. Whether you are filling out the form for the first time or need a refresher, this step-by-step guide will help you navigate each section effortlessly.

Follow the steps to confidently complete your application.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Complete the applicant's name field as it appears on your official documents.
3. Fill in the name and address of the licensed long-term care facility site, ensuring accuracy in details such as street address, city, state, and zip code.
4. Provide your social security number in the designated field, keeping in mind the importance of data privacy.
5. Enter your date of birth and place of birth, ensuring that this matches your identification documents.
6. Indicate your citizenship status by selecting either 'Yes' or 'No' and, if applicable, attach a copy of your green card declaration.
7. Fill in your home and work telephone numbers, ensuring they are current and accessible.
8. Provide your email address for official communication purposes.
9. Answer the question regarding past convictions accurately, explaining any affirmatives on the designated line.
10. Select the appropriate type of program by checking the corresponding box.
11. Detail your professional experience starting with your most recent position. For each entry, include the name and address of the employer, your title, dates of employment, hours worked weekly, and a description of your duties.
12. List your educational background, ensuring that you attach copies of all relevant transcripts. Provide the names and locations of the institutions and indicate graduation status.
13. Include information about any professional certificates and licenses you hold, ensuring to list them completely.
14. Attach any required supporting documents listed in item 17 before submitting your application.
15. Complete the fee information, ensuring you include the non-refundable $100 application fee details.
16. Sign the certification section, affirming the truthfulness of your application, and have it notarized if required.
17. Save changes, download the completed form, print it, or share it as needed to finalize your submission.

Complete your application online today and take the next step toward becoming a licensed nursing home administrator.