Get Ia Direct Care Worker Registry Application 2019-2025

Completing the IA Direct Care Worker Registry Application online is an essential step for individuals seeking to work in certified nursing facilities in Iowa. This guide will walk you through the necessary steps to efficiently fill out and submit your application.

Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to access the IA Direct Care Worker Registry Application. This will allow you to open the form in an online format for easy editing.
2. Begin with Section 1, which must be filled out by the direct care worker. Ensure that you fill in all personal information accurately, including your last name, first name, middle name, date of birth, and Social Security number. This information is crucial for verification purposes.
3. If you are transferring from another state, use the ‘State Certified (if other than IA)’ field to indicate the state where you are currently certified. Attach a copy of your current certification card and a legible copy of your Social Security card.
4. In the ‘Employment History’ section, provide a detailed account of your last three years of employment as a certified nursing assistant (CNA). List each employer in chronological order, starting with the most recent, and include hire and separation dates in the format MM-DD-YYYY.
5. If you are applying for a position with an Iowa-based hiring facility, Section 2 must be completed by your employer. If applicable, your employer must indicate your hire date and, if relevant, your separation date. Ensure all required fields are filled out and the section is signed.
6. Review all information for accuracy and completeness. It is important that the accuracy of the information provided is affirmed by your signature.
7. Once the application is fully completed and signed, it can be submitted. Use the contact information provided at the top of the form to fax or mail your completed application.
8. After submission, you can save changes, download, print, or share the form as needed. If you require a physical card, specify on the application form if you would like it mailed to you.

Complete your IA Direct Care Worker Registry Application online today and take the next step in your career.