Get New Packet Application Form .doc - Rld State Nm

This guide provides step-by-step instructions on completing the NEW Packet Application Form .doc - Rld State Nm. Whether you are applying for licensure by exam or reciprocity, this comprehensive approach will help you navigate the process smoothly.

Follow the steps to successfully complete your application

1. Press the ‘Get Form’ button to acquire the form and open it in your preferred electronic editor.
2. Begin filling out Section I: Personal Information by entering your first name, last name, Social Security Number, date of birth, middle initial, and maiden name if applicable. Additionally, provide your street address and mailing address along with your city, state, and zip code. Include your home and work phone numbers, and email address.
3. For the name to appear on the license, print it exactly as you wish. Then provide the name, address, and zip code of your current employer along with the employment start date and position held.
4. In Section II: Identification Photograph, sign the back of your photo in front of a notary public before attaching it to the form.
5. In Section III: Educational Information, ensure to enclose a copy of your Baccalaureate Degree, request official transcripts from your educational institution, and include any additional education records obtained post-Baccalaureate.
6. Complete Section IV: Licensure History by answering if you currently hold or have held any professional licenses. If applicable, list the license details, including the state, license title, license number, issue date, and expiration date. Request verification of licensure from other relevant boards.
7. Section V: Disciplinary History requires careful consideration. Answer each question honestly and attach necessary documentation if you answer 'yes' to any.
8. For Section VI: Administrator-in-Training (A.I.T.) Program, submit your Certificate of Completion of the A.I.T. program and provide details regarding the facility and supervisor.
9. In Section VII: Work History, provide information concerning your job over the last 12 years, starting from your most recent position. If a résumé is submitted, ensure that it contains all required information.
10. Complete Section VIII: References by listing three individuals who can provide written moral character references, ensuring they are not related to you. Include their contact information.
11. In Section IX: Certification, affirm that all statements are correct, sign the application, and indicate the date.
12. Finally, Section X: Notary Public requires your signature and the notary’s acknowledgment of your identity and signing presence.
13. After completing all sections, review your form carefully for accuracy. Save changes, and you may choose to download, print, or share the completed form as necessary.

Start completing your application online today and ensure a smooth submission process.