That I CANNOT PRACTICE NURSING while maintaining a retired nurse license; and that I have read and understand this application. I understanding that if the processing of this application is not completed, the application becomes null and void one year from date received and that all fees are non-refundable. I also understand that falsification of this form is grounds for disciplinary action against my license. APPLICANT S SIGNATURE FOR OFFICE USE ONLY AR CERT. NO. DATE DATE 3.10 lw 01-0022.
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How to fill out the Arsbn online
This guide provides a clear and supportive resource for individuals completing the Arkansas State Board of Nursing Retired Nurse Application online. Follow these detailed instructions to smoothly navigate the form and ensure an accurate submission.
Follow the steps to complete the application with ease.
- Click ‘Get Form’ button to obtain the application form and open it in the editor for easy access.
- Ensure your nursing license is in active or inactive status, as it cannot be transferred from 'expired' status.
- Provide your full name, including your first, middle, last, and maiden names in the designated fields.
- Enter your physical and mailing addresses, ensuring accuracy for correspondence.
- Fill in your date of birth, place of birth, and social security number following the specified format.
- Indicate your telephone number and email address in the respective fields for communication purposes.
- Select the applicable boxes for your Arkansas nursing license number(s) and the type of license (APN, RN, LPN, LPTN).
- Declare your primary state of residence by selecting Arkansas or specifying another state, if applicable.
- Select your method of payment; if using a credit card, fill in the necessary credit card information accurately.
- Sign the application, affirming the truthfulness of your statements and understanding of the nursing practice restrictions.
- Review the completed form for accuracy, then submit it along with the $10.00 fee to the Arkansas State Board of Nursing office.
Complete your application online today and keep your nursing legacy active!
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