Get New York Nursing Assistant Registry Renewal Form

Completing the New York Nursing Assistant Registry Renewal Form online is an essential step for nursing assistants looking to maintain their certification. This guide outlines each step clearly, ensuring you provide all necessary information accurately.

Follow the steps to successfully complete the online renewal form.

1. Click ‘Get Form’ button to access the New York Nursing Assistant Registry Renewal Form and open it.
2. Begin by filling out the nursing assistant information section. Provide your social security number, first name, middle initial, last name, and date of birth in the respective fields. Ensure that all required fields marked with an asterisk are completed.
3. Enter your previous name if applicable and your current street address, including apartment number or P.O. Box, city, county (first four letters only), state, and ZIP code.
4. Provide your daytime phone number, email address (mandatory for processing), and your New York State Nurse Aide Certification Number.
5. Next, move on to the employment information section. List your current or previous employer's name, facility or agency name, and the employer or facility code.
6. Fill in the address of your employer, including the street address, city, state, and ZIP code. Indicate the type of nursing assistant employer, selecting from traditional or nontraditional options.
7. Document your dates of employment as a nursing assistant, starting with the date of hire. If you are currently employed, indicate this; otherwise, provide your termination date.
8. In this section, provide the name of the person supervising your duties as a nursing assistant.
9. Complete the certification statement at the end of the employment section, ensuring to sign and date it as required.
10. Lastly, review your entire form for accuracy. Once verified, you can save changes, download, print the completed form, and prepare to mail it to Prometric with your payment.

Complete your New York Nursing Assistant Registry Renewal Form online today to ensure your certification remains active.