Get Grandfathering Attestation Form - Department Of Health - Doh Dc

The Grandfathering Attestation Form is essential for dental assistants seeking to verify their previous work. This guide will provide you with clear, step-by-step instructions on how to complete the form online efficiently and accurately.

Follow the steps to fill out the Grandfathering Attestation Form online.

1. Click ‘Get Form’ button to access the Grandfathering Attestation Form. This will open the document in an online format for you to complete.
2. Begin by entering your name as the dental assistant applicant in the designated field. Make sure to use your full legal name.
3. Next, provide the name of your place of employment, including the specific office name where you are currently working.
4. In the location section, input the full address of your office including street number, street name, city, and state.
5. Indicate your hire date and, if applicable, your end date by selecting the appropriate dates in the MM DD YYYY format.
6. Respond to the question regarding your competent performance at the office prior to and including July 15, 2011 by selecting 'Yes' or 'No'. If you choose 'No', you will need to provide the name and location of the office that will verify your experience.
7. If applicable, fill out the name of the supervising dentist as well as the location of their place of employment.
8. Answer the question about whether this individual was under your supervision prior to and including July 15, 2011 by selecting 'Yes' or 'No'.
9. Finally, sign the attestation by entering your name in the designated signature area, followed by the date you are completing the form.
10. After completing all the fields, ensure that all information is accurate. You can now save your changes, download the document, print it for your records, or share it as required.

Complete your Grandfathering Attestation Form online today to ensure smooth processing of your application.