Follow the steps to complete the Natcep Kansas Form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred document editor.
2. Enter your name in the designated field. Make sure it matches your legal identification.
3. Provide your home address, including city, state, and zip code. Ensure accuracy for correspondence purposes.
4. Fill in your home and work phone numbers, including the area code. This information allows for direct communication if needed.
5. Insert your Registered Nurse (RN) or Licensed Practical Nurse (LPN) license number, along with the expiration date to verify your qualifications.
6. Indicate whether your nursing license is encumbered or limited due to any disciplinary action. If yes, provide a brief description of the circumstances.
7. List the name and mailing address of the nursing assistant training program where you will serve as an instructor, including the program's phone number.
8. Complete the employment history chart for the past three years. Provide the dates of hire and termination, along with employers and job titles.
9. Answer the questions regarding your training in adult instruction. If applicable, indicate if you have supervised nursing assistants, providing further details if necessary.
10. Specify your primary teaching responsibilities by checking the appropriate boxes for classroom, clinical, or both.
11. Finally, sign and date the form to confirm the accuracy of the information provided.
12. After completing the form, save any changes you made, and consider downloading or printing it for your records or future submissions.

Complete your Natcep Kansas Form online today and ensure your application is submitted accurately.