Get Hi Nurse Aide Testing/ Out Of State/ Reciprocity Application Form 2013-2025

Filling out the HI Nurse Aide Testing/ Out of State/ Reciprocity Application Form is an essential step for individuals seeking to become certified nurse aides in Hawaii. This guide will assist you in completing the application accurately and efficiently online.

Follow the steps to complete the application accurately.

1. Click the ‘Get Form’ button to obtain the application form and open it in the editor.
2. Begin by providing your candidate information. Ensure that your name matches exactly with the government issued identification you will present at the testing. Enter your social security number, date of birth, last name, first name, middle initial, and contact details including your home address and email address.
3. Indicate whether you have previously taken the Certified Nurse Aide exam by selecting 'Yes' or 'No'. If you have tested in Hawaii before, provide your previous name if applicable.
4. Declare your eligibility by indicating your citizenship status and confirming that you are at least 18 years of age. You will also need to select your certification option, choosing from the available routes: Testing Candidate, Reciprocity/Out of State, or Lapsed/Expired.
5. If applicable, fill out the training information section, providing details regarding your training completion date, total hours, and the name and address of your training program.
6. Answer the additional mandatory questions by checking 'Yes' or 'No' for each question. Should you answer 'Yes', provide a detailed explanation on a separate page as required.
7. Complete the Route 2 information if you are applying through Reciprocity/Out of State. This includes your current certification number, employment status as a nurse aide, and the name and address of your current employer.
8. Select your preferred test site from the list provided. Ensure that you understand the scheduling process if testing at your facility versus a regional test site.
9. Review the exam selection and associated fees. Ensure you select the correct options reflecting your situation, whether you are a first-time tester, lapsed candidate, or retester.
10. Complete the payment options section, as payment must be made via certified check or money order, or by credit card. Fill in the necessary card information if using this payment method.
11. Sign the applicant’s affidavit and candidate release statement. Ensure you understand and agree to the terms. Also, provide your signature and the date.
12. If you are currently employed as a nurse aide, fill in your employment information. Depending on your testing route, either submit your form to the facility coordinator or mail it to the designated Prometric address.
13. Finally, review all entries for completeness and clarity. After confirming that all required fields are filled properly, save changes, download, or print the form for your records.

Complete your application online today to ensure a smooth and efficient certification process.