Get Application For Licensure - Hawaii Department Of Health

Filling out the Application For Licensure with the Hawaii Department of Health is an essential step for individuals seeking licensure as a medical laboratory technician. This guide will provide you with clear, step-by-step instructions to ensure you complete the application accurately and effectively.

Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by providing your full name, including your first, middle, and last names. Ensure you enter your name clearly to avoid any potential issues with your application.
3. Next, enter your Social Security Number (last four digits only) along with your date of birth to verify your identity.
4. Complete the home address section by providing your street address, city, state, and zip code. This information must be accurate, as it will be used for correspondence.
5. Fill in the telephone numbers for both your residence and business. Please ensure that these numbers are current and accessible.
6. Provide your email address, as this will be used for electronic correspondence regarding your application.
7. List your employer’s name and address, along with any relevant details about your current or prior positions that relate to your qualifications.
8. In the education section, provide information about your high school, training or technical school, and college or university. Include the years attended, your major or minor, and the degree received along with the date.
9. Detail all professional experience or training during the past five years. Attach a separate description of duties performed at each position.
10. If you hold any other current and valid state licenses, list them including which state issued the license, license category, number, and the date issued.
11. Respond to the professional certification section, indicating the name of the agency that issued your certification, if applicable.
12. Answer the two questions regarding any previous disciplinary actions or investigations concerning your performance as a clinical laboratory professional.
13. Read and affirm the certification statement to ensure you are providing truthful information to the best of your knowledge. Then, provide your signature in ink to finalize your application.
14. Once you have completed all sections of the application and attached any required documents, save your changes, download, print, or share the form as necessary.

Complete your application and take the next step toward your licensure online today.