Get Individual Safe Examiner Application - New York State Department ... - Health Ny

This guide provides clear instructions for completing the Individual SAFE Examiner Application for the New York State Department of Health. Whether you are applying for initial certification or re-certification, you will find step-by-step guidance tailored to your needs.

Follow the steps to complete your application accurately.

1. Click ‘Get Form’ button to obtain the application form and open it in your browser.
2. Begin by filling in your personal details, including your name, date of birth, and address. Ensure that all information is accurate and up-to-date.
3. Provide your contact information including telephone number and email address. Double-check for correct formatting to avoid communication issues.
4. Select your applicant type by checking the appropriate box: Registered Nurse, Physician, Nurse Practitioner, or Physician Assistant. Only one checkbox should be marked.
5. If applicable, enter your license number and check the box indicating if you are IAFN SANE-A certified.
6. Indicate the type of certification requested by selecting either 'Initial' or 'Re-certification'. Make sure this reflects your current application status.
7. Prepare to attach the checklist of required documentation based on whether you are applying for initial certification or re-certification. Ensure all necessary documents are included.
8. Complete the required checklist and check off each item to confirm you have included them in your application. This may include proof of training and experience.
9. Sign the application to certify that all information provided is true and complete.
10. Submit your complete application package to the specified address in Albany, NY. You can save your completed form for your records, download it as a PDF, or print it if needed.

Ensure your application is submitted correctly by following these steps carefully.