Get Ar Doh Ar920390z 2020-2025

The AR DoH AR920390Z is a crucial form required for various licensure processes within the Arkansas Department of Health. This guide will provide a clear and structured approach to completing the form effectively, ensuring that users understand each step involved in the process.

Follow the steps to successfully complete the form online.

1. Click the ‘Get Form’ button to access the AR920390Z document. This will allow you to download or open the form in your preferred document editor.
2. Fill in the EMS/School Affiliation section by entering the relevant information about your affiliated program or institution, including the name of your supervisor or instructor and the course number.
3. Indicate the type of background check required: either select 'State Check only' or 'State and FBI Check'. Make sure to check one of these options according to your needs.
4. In the personal information section, fill out your last name, first name, middle name, and maiden name as applicable. Also provide your date of birth, race, driver's license number, sex, state of issue, county, and social security number.
5. Complete the contact information sections by entering your current mailing address, along with your city, state, and zip code. Additionally, provide your physical address if it differs from your mailing address, as well as your current email address.
6. List any felony or misdemeanor charges for which you have been found guilty. Include the date, location, description, and sentence for each charge.
7. Select the form of identification you will provide, such as a driver's license or state identification card, and ensure the document adequately reflects your identity with date of birth listed.
8. Review the fees indicated: a civil records check for $22.00 and an FBI records check for $14.25. Ensure these are calculated and paid, as specified.
9. Read the statement of oath and check the box that applies to your residency in Arkansas to affirm your status as either a long-term resident or a new resident.
10. Sign and date the document in blue ink where indicated. If applicable, ensure a guardian's signature is provided if the applicant is under the age of sixteen.
11. Notarize the form. Ensure that a notary public signs and dates in the provided section for the document to be officially recognized.
12. Upon completing the form, save your changes, and then choose to download, print, or share the completed document as needed.

Take the next step and complete the AR DoH AR920390Z online to ensure your application is processed smoothly.