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Get Oh Den1003 2004-2026
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How to fill out the OH DEN1003 online
This guide provides a comprehensive overview of the OH DEN1003 application for reinstatement of dental hygiene licenses in Ohio. It offers clear, step-by-step instructions tailored to help you navigate the process smoothly.
Follow the steps to successfully complete the OH DEN1003 form.
- Click ‘Get Form’ button to access the OH DEN1003 application and open it in your preferred online editing tool.
- Fill in your present legal name. Ensure that you print your first, middle, and last names as well as any maiden names if applicable.
- Provide your address, including your street number, city, state, and zip code, ensuring all information is accurate.
- Input your telephone numbers — both home and business — clearly stating the respective numbers.
- Enter your Social Security number in the specified field, following the instructions about confidentiality.
- Specify your intended place of practice, including the street address, city, state, and zip code.
- List any other state licenses you hold, detailing the jurisdiction, license number, date of issuance, years of practice, and method of licensure.
- Respond to questions regarding any refusals of licensure, disqualifications, or disciplinary actions. Attach necessary statements if you answer 'yes' to certain conditions.
- Complete the criminal history section, disclosing any felony or misdemeanor convictions and any pending criminal charges.
- Submit required documentation such as proof of continuing education, a criminal records check, and immunization records against hepatitis B.
- Ensure that two licensed dentists complete the Certificates of Good Moral Character to affirm your qualifications.
- Review the entire application for accuracy and completeness before submitting it. Save your changes, download, or print a copy of the completed form.
Take the next step towards reinstating your dental hygiene license by completing the OH DEN1003 form online today.
When completing a withholding exemption form, accurately enter your personal details, including your name and social security number. Clearly state the reasons for requesting an exemption, and ensure you sign and date the form to validate it. If you need additional help, accessing information from OH DEN1003 on UsLegalForms can guide you through every step.
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