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Get WA DSHS 16-193 2016-2021

Ov All forms must be type written to be processed. DSHS web address: https://www.dshs.wa.gov/altsa/residential-care-services/nursing-assistant-program-0 All columns must be completed. Please include previous work history and dates. FACILITY NAME CONTACT PERSON TELEPHONE NUMBER RETURN EMAIL ADDRESS Starting October 1st, 2016, we will no longer process faxed or incomplete forms. Please allow 24 – 48 hours for processing (excluding weekends and holidays). ADDRESS CITY STATE ZIP CODE For .

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