Get Ny Doh-4332 2022-2026

Filling out the NY DOH-4332 form is an essential step for individuals seeking initial certification as an euthanasia technician for animals in New York State. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to successfully complete your application.

1. Click the ‘Get Form’ button to access the NY DOH-4332 form online.
2. Begin by entering your personal information in the 'Applicant' section. Fill in your first name, middle initial, last name, and date of birth. Ensure that you provide your home address, including your street, city, state, and zip code. Additionally, input your cell phone number, other phone number, email address, and county of residence.
3. In the 'College' section, indicate your degree type, major, and the date received. If applicable, provide the name and address of your college. Remember that if you do not have a college degree, you must include documentation of two years of experience in animal care, specifically in euthanasia.
4. Complete the 'Applicant Affirmation' section by checking the appropriate box regarding any felony convictions related to controlled substances. Ensure that you affirm the truthfulness of the information provided.
5. Sign and date the form in the 'Applicant’s Signature' section to validate your application.
6. Proceed to the 'Certification of Experience/Training' section. Here, two licensed veterinarians must attest to your training in the use of injections for euthanasia. Ensure that they print their names and provide their New York State Education Department (NYSED) license numbers.
7. Complete the 'Employment Verification' section by having the Chief Official or Head Supervisor of your employing facility attest to your employment. They should provide their name, the name of the facility, BNE Facility Registration number, job title, and business address.
8. Once the form is fully completed, review all entries for accuracy. You can then save any changes, download a copy, or print the form for submission.
9. Finally, submit your completed application via email to bnelicensing@health.ny.gov, fax it to 518-402-0709, or mail it if necessary to the Bureau of Narcotic Enforcement at the designated address.

Start filling out your NY DOH-4332 form online today for a seamless application process.