Get Certification Of Experience - Op Nysed

The Certification of Experience is a crucial document needed for licensure application in New York. This guide will provide comprehensive, step-by-step instructions on how to fill out the form effectively and accurately online, ensuring that you complete each required section.

Follow the steps to complete your Certification of Experience form online.

1. Click ‘Get Form’ button to obtain the Certification of Experience form and open it in your preferred editing program.
2. In Section I, fill out your personal information in ink. Ensure you enter your name exactly as it appears on your licensure application. This includes your last name, first name, and middle name.
3. Provide your Social Security Number in the designated field. If you do not have a U.S. Social Security Number, leave this blank.
4. Enter your birth date using the format of month, day, and year.
5. Complete your mailing address, ensuring accuracy to receive any correspondence. Notify the Department of any changes promptly.
6. In the following sections, name your employer and provide their full address.
7. Include the name and address of your supervisor. If the supervisor's address differs from the employer's address, specify that as well.
8. If your practice address is different from that of your employer, provide that information as well.
9. Sign and date item 10, granting permission for your employer and supervisor to complete the required information and send any necessary documents directly to the Office of the Professions.
10. Once Section I is completed, send the form to your supervisor whom you worked with, so they can complete Section II.
11. In Section II, the supervisor must fill out the dates they supervised you, provide their signature, and include the relevant details regarding your duties and experience.
12. After the supervisor has certified your experience, they must return the form directly to the Office of the Professions — do not submit it yourself.
13. Finally, ensure all sections are complete before saving, downloading, or printing the form for submission.

Start filling out your Certification of Experience form online today!