Get Employment Verification Form - Prometric - Ct

Filling out the Employment Verification Form for Connecticut's Nurse Aide Registry is a straightforward process. This guide will provide you with step-by-step instructions to ensure that you complete the form accurately and efficiently.

Follow the steps to fill out the Employment Verification Form online.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. In the first section, complete the information as prompted. Begin with your full name, ensuring it is clearly printed in the designated area.
3. Next, provide your current address including street, city, state, and zip code. Be sure to check for accuracy.
4. Enter your telephone number and email address. These are important for communication regarding your verification.
5. Fill in your Connecticut Nurse Aide Registration Number and Social Security Number as required. Double-check for typographical errors.
6. Indicate if you are certified as a nurse aide in any other states. If your answer is 'Yes', please specify the states in the following space.
7. In the employer section, the employer needs to complete the information regarding the facility or agency. They will print the facility or agency name and address.
8. The employer should provide the employer code if applicable, then state the date of hire, last reported date of employment, and termination date if necessary.
9. The employer representative must print their name, provide their telephone number, sign the form, and include the date of signing.
10. Once all sections of the form are completed, ensure all information is accurate. You can then save changes, download the completed form, print it, or share it as necessary.

Complete your Employment Verification Form online today to ensure timely processing.