Follow the steps to successfully complete your application

1. Click ‘Get Form’ button to obtain the application form and open it in the editor.
2. Type or print in black ink your full name in the designated fields: last name, first name, and middle name. Ensure accuracy to avoid processing delays.
3. Fill in your Social Security Number. This information is required for processing your application.
4. Complete the applicant history section. Answer the questions regarding your medical history honestly, and provide additional sheets if you answer 'Yes' to any of the questions.
5. Provide your personal profile data, including your mailing address, home and business telephone numbers, date of birth, place of birth, and email address.
6. Specify your primary practice location by entering the physical address, including the street number, city, and state.
7. For the equal opportunity data section, complete voluntarily for statistical purposes while ensuring that you understand this does not impact your application.
8. Answer the general history questions regarding any past convictions or disciplinary actions, providing additional documentation as necessary.
9. In the duties section, review and acknowledge the functions you will be performing as a registered chiropractic assistant.
10. Complete the employer/supervisor profile with accurate details of your current or prospective supervising chiropractor.
11. Sign and date the application in the applicant statement section, affirming that all information provided is true and complete.
12. Finally, review your completed application. Once satisfied, save your changes, and prepare to submit by mailing it with the necessary fees to the specified address.

Complete your application online to take the next step in your chiropractic career.