Get Georgia Nha Application Form

Filling out the Georgia Nha Application Form online can seem daunting, but with the right guidance, it can be a straightforward process. This guide will walk you through each section of the form to ensure you complete it accurately and efficiently.

Follow the steps to complete your application online

1. Click 'Get Form' button to access the application form. This action will allow you to obtain the document and open it in your preferred editor.
2. Begin by filling out Part I, which requires your personal information. Enter your name, home address, business address, phone numbers, email address, social security number, and date of birth. Make sure to type or print clearly.
3. In Part II, provide your educational background. List the high school you attended, along with the city and state. Include the dates you attended and the degree earned. If applicable, submit supporting documents like your high school diploma, GED certificate, or college transcripts.
4. Complete Part III by detailing your professional background. If you hold any professional licenses, list them along with the state, date issued, and expiration date. Answer the questions regarding disciplinary actions, license revocation, or other legal matters, providing additional explanations if necessary.
5. If you completed an Administrator-in-Training (AIT) program in Georgia, fill out Part IV. Include the name of the nursing home, your preceptor's name, and the duration of the program.
6. In Part V, provide information about your current employment. Fill out the company name, facility type, position, address, and contact numbers. Don’t forget to include your employment dates and whether your work is full-time or part-time.
7. For applications by endorsement, move on to Part VI. List all states where you have held a Nursing Home Administrator License, including the issue and expiration dates.
8. Finally, complete Part VII with your oath. Affirm that all information provided is true and correct, sign the application, and provide the date. Don't forget to include the notary public's signature and seal, if required.
9. Once you have filled out the entire application, review all entries for accuracy. After confirming that all sections are complete, you can save your changes, download a copy of the form, or print it for future reference.

Start your application process online today by following these steps.