Contents
Form Example
Texas Nurse Aide Registry |
Form |
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December |
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Request for Entry on the Texas Nurse Aide Registry Through Reciprocity |
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Applicant Information (To be completed by applicant.)
Note: You are not eligible to be employed as a nurse aide in the state of Texas until your request has been approved and you have been entered into the registry.
Read the following instructions before completing this form.
•Complete all information in Section 1. Your signature is required at the bottom of Section 1 to verify that information you provided is correct.
•Once Section 1 is complete, email this form, a legible copy of a government issued identification that shows your birth date and the correct spelling of your name, copy of your Social Security card, and your Texas criminal history results for all legal last names you ever had from the Texas Department of Public Safety at publicsite.dps.texas.gov/ConvictionNameSearch to: nurseaideregistry@hhs.texas.gov (See back of form for more instructions.)
•If you do not have an expiration date in the state you are active in, you must also complete and submit Form
Name (Last, First, Middle): |
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Maiden Name (if applicable): |
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Social Security No.: |
Sex: |
Date of Birth: |
Email Address: |
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Male |
Female |
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Mailing Address (Street or P.O. Box):
City:
State:
ZIP Code:
Phone No.:
State(s) Where Issued:
Nurse Aide Certificate No.(s)
Issue Date(s):
Signature – Applicant
Date
You must submit the following items:
Completed Form
Copy of your government issued current photo ID
Copy of your Social Security card
Texas Department of Public Safety criminal history check for all legal last names ever had (either Fingerprint Cards with results or Name Based completed online for all last names ever used)
Email the completed form and required documents to the Texas Nurse Aide Registry at nurseaideregistry@hhs.texas.gov.
Form
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Address:
Instructions
Nurse Aides who are listed active on a registry in another state and are requesting to be placed on the Texas Nurse Aide Registry by reciprocity must meet eligibility requirements listed, per Texas Standards for Nurse Aides, Section twenty six26 TAC
Nurse Aide Registry staff will complete the EMR check.
The person requesting reciprocity must obtain a criminal history check from the Texas Department of Public Safety (DPS). For instructions on how a person can obtain a
You must submit your criminal history results along with the reciprocity Form
Applicant, did you:
•Sign the form?
•Include your criminal history results for all last names you ever had, a legible photocopy of your state issued picture identification showing your birth date and correct spelling of your name, and a copy of your Social Security card?
Did you know?
•You can verify certificate status by using the following link: emr.dads.state.tx.us/DadsEMRWeb/
•You can download forms from our website:
With a few exceptions, you have the right to request and be informed about the information that the Texas Health and Human Services Commission (HHSC) obtains about you. You are entitled to receive and review the information upon request. You also have the right to ask HHSC to correct information that is determined to be incorrect (Government Code, Sections 552.021, 552.023, 559.004). To find out about your information and your right to request correction, please call the Nurse Aide Registry at
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Common mistakes
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Not providing complete personal information. Ensure that all sections, including your name, address, and contact details, are filled out accurately.
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Forgetting to sign the form. A signature is necessary to validate your application. Double-check that you have signed where required.
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Using incorrect or outdated contact information. Make sure to provide current phone numbers and email addresses so that the registry can reach you easily.
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Neglecting to include required documentation. Review the form’s instructions carefully to ensure you attach all necessary documents.
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Failing to read the instructions thoroughly. Each section of the form has specific requirements. Take your time to understand what is needed.
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Leaving out information about previous employment. If you have worked in healthcare before, include all relevant experience as it is crucial for your application.
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Not checking for typos or errors. Simple mistakes can delay your application. Proofread your form before submission.
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Submitting the form without a copy for personal records. Always keep a copy of your completed form for your own reference.
Key takeaways
When filling out and using the Texas Nurse Aide Registry 5505-NAR form, it is essential to keep several key points in mind. The following takeaways will help ensure a smooth process:
- Accurate Information: Provide complete and accurate personal information. This includes your full name, address, and contact details.
- Signature Requirement: Ensure that you sign the form. An unsigned form will not be processed.
- Application Fee: Be aware that there is a fee associated with the application. Confirm the amount and acceptable payment methods.
- Submission Methods: You can submit the form by mail or online, depending on the instructions provided. Choose the method that best suits your needs.
- Documentation: Attach any required documentation, such as proof of training or certification. Incomplete submissions may delay processing.
- Processing Time: Understand that processing times may vary. Check the Texas Nurse Aide Registry website for current timelines.
- Renewal Information: If you are renewing your certification, be sure to follow the specific renewal guidelines outlined in the form.
- Contact Information: Keep the contact information for the Texas Nurse Aide Registry handy. This will be useful for any questions or follow-up inquiries.
- Check for Updates: Regularly check for any updates or changes to the form or process. Staying informed will help avoid potential issues.
By following these guidelines, you can effectively navigate the Texas Nurse Aide Registry 5505-NAR form process.
Steps to Using Texas Nurse Aide Registry 5505-NAR
Filling out the Texas Nurse Aide Registry 5505-NAR form is a straightforward process that requires attention to detail. Once you have completed the form, you will be ready to submit it for processing. This step is essential for ensuring that your application is handled efficiently and accurately.
- Begin by gathering all necessary personal information, including your full name, address, phone number, and email address.
- Locate the section for your Social Security number. Ensure you enter this information correctly, as it is crucial for identification purposes.
- Provide details about your date of birth. This helps verify your identity and eligibility.
- Fill in your education history. Include the name of the institution, dates attended, and any relevant certifications or degrees.
- Indicate your employment history. List your previous jobs, including the name of the employer, position held, and dates of employment.
- Review the section regarding any criminal history. Be honest and thorough when answering these questions, as they are vital for your application.
- Sign and date the form at the bottom. Your signature confirms that all information provided is accurate to the best of your knowledge.
- Make a copy of the completed form for your records before submission.
- Submit the form according to the instructions provided, ensuring it reaches the appropriate office in a timely manner.
Following these steps will help you complete the Texas Nurse Aide Registry 5505-NAR form accurately. Take your time, double-check your entries, and ensure everything is filled out correctly before submission.