Homepage > Blank Cna License To Florida Template
Article Guide

Applying for a Certified Nursing Assistant (CNA) license in Florida involves several important steps, starting with a comprehensive application form. The process may seem daunting, but it is essential to understand the requirements to avoid delays. Among the key elements of the application is the need for a completed application form that is fully answered and signed. Each section requires honest responses, as providing false information can lead to denial. Furthermore, applicants must submit proof of active certification from their previous state, ensuring it is in good standing. A crucial aspect of the process is the **Livescan** fingerprinting, which must be completed through an approved provider. This ensures a background check can be performed. Additional required documents include the Confidential and Exempt from Public Records Disclosure Form and potentially various disclosures related to any criminal history or disciplinary actions from previous healthcare licenses. This thorough documentation process ensures the safety and integrity of nursing care in Florida, balancing the need for quick processing with the necessity of maintaining standards. Knowing and preparing for these requirements will help make the application journey smoother.

Form Sample

Application Checklist

Please use the following checklist to help ensure your application is complete.

Completed Application with Signature

An incomplete application will delay final approval of that application. All documents become a permanent part of your file and cannot be returned. Applications are reviewed in date order received.

Every question on the application must be answered. Be sure to answer all questions honestly. The Board of Nursing may deny your application if you provide false information on your application.

Proof of Active Certification

Your out-of-state certificate must be Clear/Active and in good standing.

Completed Confidential and Exempt from Public Records Disclosure Form

Form enclosed

Livescan

All applications received must include electronically submitted fingerprints through a Livescan provider. The Department of Health accepts electronic fingerprinting offered by Livescan providers that are approved by the Florida Department of Law Enforcement.

For a list of approved Livescan vendors BOE 'SFRVFOUMZ"TLFE2VFTUJPOTBCPVU-JWFsDBOplease visit our website at: http://www.flhealthsource.gov/background-screening/

Our current ORI number is EDOH4400Z.

IUUQ GMPSJEBTOVSTJOHHPWGPSNTFMFDUSPOJDGJOHFSQSJOUJOHGPSNDOBCZFYBNQEG

Applications and other additional documents must be mailed to:

Department of Health

Certified Nursing Assistant Registry

4052 Bald Cypress Way Bin# C-02

Tallahassee, FL 32399-3252

DH-MQA 5022 06/18, Rule 64B9-15.0035, FAC

Important Information

Application Updates

The Board office must be notified in writing of anything which changes or affects a response given in your application. Failure to do so could result in the delay of application processing or denial of your application. Examples: change of name, address, telephone number, arrests or convictions, licensure status or disciplinary action in another state, or an incorrect answer to a question.

Withdrawal of Application

If you decide to withdraw your application, you must make the request in writing. The request must be received prior to the Board considering licensure.

Criminal History

Any applicant who has ever been found guilty of, or pled guilty or no contest to/nolo contendere, any charge other than a minor traffic offense must list each offense on the application. Failure to disclose criminal history may result in denial of your application. Each application is reviewed on its own merits. Staff cannot make predeterminations in advance as laws and rules do change over time.

Violent crimes and repeat offenders are required to be presented to the Board of Nursing for review.

Applicants with criminal convictions may be required to submit the following documents:

Final Dispositions/Sanctions Final disposition records for offenses can be obtained at the

clerk of the court in the arresting jurisdiction. If the records are not available, you must have a letter on court letterhead sent from the Clerk of the Court attesting to their unavailability.

Completion of Probation/Parole –Probation records for offenses can be obtained at the clerk of the court in the arresting jurisdiction. If the records are not available, you must have a letter on court letterhead sent from the Clerk of the Court attesting to their unavailability.

Self-Explanation –Applicants who have listed offenses on the application must submit a letter in your own words describing the circumstances of the offense.

Letters of Recommendation –Applicants who have listed offenses on the application must submit 3-5 letters of recommendation from people you have worked for or with.

Disciplinary History

Any applicant who has ever been denied, had disciplinary action, or surrendered a license to practice in any healthcare profession, in any state, jurisdiction, or country must provide a self-explanation of all occurrences of denial, disciplinary action or surrendering of a license. The State Board(s) of Nursing involved must also submit copies of the administrative complaint and final order directly to the Florida Board. Applicants are responsible to ensure that the proper documentation is sent to the Florida Board. Any action taken against your license by a state licensing board must be reported on this application.

Healthcare Fraud

IMPORTANT NOTICE: Applicants for licensure, certification or registration and candidates for examination may be excluded from licensure; certification or registration if their felony conviction falls into certain timeframes as established in Section 456.0635(2), Florida Statutes. For more information,

please visit our website at: http://floridasnursing.gov/licensing/certified-nursing-assistant-endorsement/.

DH-MQA 5022 06/18, Rule 64B9-15.0035, FAC

Florida Board of Nursing

PO Box 6330

Tallahassee, FL 32314

Phone: (850) 245-4125

Fax: (850) 617-6460

Certified Nursing Assistant Licensure by Endorsement Application

Website: www.floridasnursing.gov

Email: [email protected]

Please complete this application in its

entirety prior to printing.

1.PERSONAL INFORMATION

Name:

 

 

 

 

 

Date of Birth:

 

 

Last/Surname

First

 

Middle

 

MM/DD/YYYY

Mailing Address: (Give the address where mail and your license should be sent)

 

 

 

 

 

 

 

 

 

 

 

 

 

Street/P.O. Box

 

 

 

 

 

Apt. No.

 

 

City

 

 

 

 

 

 

 

 

 

 

 

 

 

State

 

Zip

Country

Home/Cell Telephone (Input with dashes)

 

Physical Location: (Required if mailing address is a P.O. Box- This address will be posted on the Department of Health's website.)

Street

 

 

 

Apt./Suite No.

City

 

 

 

 

 

 

 

 

State

 

Zip

Country

Work/Cell Telephone (Input with dashes)

EQUAL OPPORTUNITY DATA:

We are required to ask that you furnish the following information as part of your voluntary compliance with Section 2, Uniform Guidelines on Employee Selection Procedure (1978) 43 CFR 38295 and 38296 (August 25, 1978). This information is gathered for statistical and reporting purposes only and does not in any way affect your candidacy for licensure.

SEX:

Male

Female

RACE:

White

 

 

 

 

Black or African American

 

 

 

 

Hispanic

 

 

 

 

American Indian or Alaska Native

 

 

 

 

Asian

 

 

 

 

Native Hawaiian or Other Pacific Islander

 

 

 

 

Two or More Races

DH-MQA 5022 06/18, Rule 64B9-15.0035, FAC

Page 1

NAME

Email Notification: If you want to be notified of the status of your application by email please check the "Yes" box and write your email address on the line provided below. If you choose this form of notification you will receive information

regarding your application file through email. You will be responsible for checking your email regularly and updating your email address with the Board office at: [email protected]

I want to be notified by email

Yes

No

 

 

Email Address:

 

 

 

Under Florida law, email addresses are public records. If you do not want your e-mail address released in response to a public records request, do not provide an email address or send electronic mail to our office. Instead contact the office by phone or in writing.

2.APPLICANT BACKGROUND Attach additional sheets, if necessary

A.List any other name(s) by which you have been known in the past.

B.What name(s) did you use when you received your education?

C.What name did you use when you were first licensed?

D.Have you ever applied for licensure by examination in Florida, as a CNA? Date

Yes No

E.Have you ever applied for licensure by endorsement in Florida, as a CNA? Date

Yes No

F.Have you ever been licensed in Florida as a CNA? Date

Yes No

G.* Have you ever been denied or is there now any proceeding to deny your application for any health care license to practice in Florida or any other state, jurisdiction or country?

Yes No

*If you answer “Yes” to question G in this section, you must submit a self explanation as to why you are answering “Yes” to this question.

DH-MQA 5022 06/18, Rule 64B9-15.0035, FAC

Page 2

NAME

H. List all CNA licenses ( active, inactive or lapsed)

 

State/Country

 

 

License No.

 

License Type Date of Licensure

 

Status of License and Expiry Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Florida Board of Nursing requires verification of licensure from from a state where you have a current active license.

3.

A.

B.

C.

CRIMINAL HISTORY

Answers to commonly asked questions can be found on our website at:

 

 

 

http://www.floridasnursing.gov/help-center/#faqs

Yes

No

Have you EVER been convicted of, or entered a plea of guilty, nolo contendere, or no

 

 

contest to, a crime in any jurisdiction other than a minor traffic offense? You must

 

 

include all misdemeanors and felonies, even if adjudication was withheld.

 

 

Reckless driving, driving while license suspended or revoked (DWLSR), driving

 

 

under the influence (DUI) or driving while impaired (DWI) are not minor traffic offenses

 

 

for purposes of this question.

Yes

No Have you EVER had any records sealed pursuant to section 943.059, F.S., or other states

 

 

applicable statute?

Yes

No

Have you EVER been adjudicated delinquent?

Failure to disclose information in this section may result in a denial of your application.

If you answered “Yes” to any of the questions above you are required to send the following items:

Self Explanation describing in detail the circumstances surrounding each offense; including dates, city and state, charges and final results.

Final Dispositions and Arrest Records for all offenses. The Clerk of the Court in the arresting jurisdiction will provide you with these documents. Unavailability of these documents must come in the form of a letter from the Clerk of the Court.

Completion of Sentence Documents. You may obtain documents from the Department

of Corrections. The report must include the start date, end date, and state that the conditions have been met.

Three (3) current (written within the last year) Letters of Recommendation.

DH-MQA 5022 06/18, Rule 64B9-15.0035, FAC

Page 3

NAME

4.

Electronic Fingerprinting:

(Required for ALL applicants)

 

 

 

 

All applicants, including out-of-state and out-of-country applicants, are required to submit their fingerprints electronically. The Department of Health accepts electronic fingerprinting offered by Livescan device providers that are approved by the Florida Department of Law Enforcement. For a list of approved Livescan vendors, please visit our website at : http://www.flhealthsource.gov/background-screening/

Typically background results submitted by Livescan are received by the Board within 24-72 hours of being processed. The Board of Nursing's ORI number is: ED0380Z. The Board cannot accept hard fingerprint cards or results. All results must be submitted electronically by the Livescan service provider.

Livescan screenings done by a Florida Police or Sheriff's Department require that you login to the FDLE Civil Applicant Payment System (CAPS) at https://caps.fdle.state.fl.us and pay a fee before results will be released to our office.

Applicants who reside in an area where no Livescan service providers are available or because of state laws prohibiting transmission of fingerprints electronically across state lines should contact a Florida Livescan service provider who has the capability to convert a traditional card (hard card) into an electronic fingerprint card.

Because the Florida Department of Health retains fingerprints on any applicant who is required to undergo a criminal history screening as of January 1, 2013, those prints are retained in the Care Provider Clearinghouse. This Clearinghouse allows for the sharing of criminal history information among specified agencies.

One of the requirements for your Livescan to be retained in the Clearinghouse is a photograph taken by the Livescan service provider at time of fingerprinting. If your Livescan is completed without a photograph, you may have to undergo additional fingerprinting in the future.

Applicants needing hard fingerprint cards can request them via email at: [email protected]

Please include your current mailing address in your request for fingerprint cards.

The Board cannot accept hard fingerprint cards or results.

For Frequently Asked Questions about Livescan and for a list of providers who offer hard card conversion see our website at:

http://www.flhealthsource.gov/background-screening/

LIVESCAN PRIVACY STATEMENT

I have been provided and read the statement from the Florida Department of Law Enforcement regarding the sharing, retention, privacy and right to challenge incorrect criminal history records and the “Privacy Statement” document from the Federal Bureau of Investigation. (Found in the forms following this application). The Board will not receive your Livescan results if you do not affirm the above statement by checking this box.

DH-MQA 5022 06/18, Rule 64B9-15.0035, FAC

Page4

NAME

5.

A.

B.

C.

DISCIPLINARY HISTORY

Yes

No

Have you ever had disciplinary action taken against your license to practice any

 

 

health care related profession by the licensing authority in Florida or in any other state,

 

 

jurisdiction or country?

Yes No Have you ever surrendered a license to practice any health care related profession in Florida or in any other state, jurisdiction or country while any such disciplinary charges were pending against you?

Yes No Do you have disciplinary action pending against any license?

Failure to disclose information in this section may result in a denial of your application.

If you answered “Yes” to any of the questions in this section, you are required to send the following items:

Self Explanation, describing in detail the circumstances surrounding the disciplinary action.

A copy of the Administrative Complaint and Final Order.

Three (3) current (written within the last year) Letters of Recommendation.

6. CRIMINAL AND MEDICAID/MEDICARE FRAUD QUESTIONS

IMPORTANT NOTICE: Applicants for licensure, certification or registration and candidates for examination may be excluded from licensure, certification or registration if their felony conviction falls into certain timeframes as established in Section 456.0635(2), Florida Statutes. If you answer “Yes” to any of the following questions, please provide a written explanation for each question including the county and state of each termination or conviction, date of each termination or conviction, and copies of supporting documentation to the address below. Supporting documentation includes court dispositions or agency orders where applicable.

1. Yes No Have you been convicted of, or entered a plea of guilty or nolo contendere, regardless of adjudication, to a felony under Chapter 409, F.S. (relating to social and economic assistance), Chapter 817, F.S. (relating to fraudulent practices), Chapter 893, F.S. (relating to drug abuse prevention and control) or a similar felony offense(s) in another state or jurisdiction?

If you responded “No”to the question above, skip to question 2.

a

.

Yes

No If “Yes” to 1, were you arrested or charged for the felony or felonies after July 1, 2009?

b.

Yes

No If “Yes” to 1, for the felonies of the first or second degree, has it been more than 15

 

 

 

years from the date of the plea, sentence and completion of any subsequent probation?

c. Yes No If “Yes” to 1, for the felonies of the third degree, has it been more than 10 years from the date of the plea, sentence and completion of any subsequent probation? (This question does not apply to felonies of the third degree under Section 893.13(6)(a), Florida Statutes).

DH-MQA 5022 06/18, Rule 64B9-15.0035, FAC

Page 5

NAME ______________________________________________

d. Yes No If “Yes” to 1, for the felonies of the third degree under Section 893.13(6)(a), Florida Statutes, has it been more than 5 years from the date of the plea, sentence and completion of any subsequent probation?

2.

e. Yes No

Yes No

If “Yes” to 1, have you successfully completed a drug court program that resulted in the plea for the felony offense being withdrawn or the charges dismissed? (If “Yes”, please provide supporting documentation).

Have you been convicted of, or entered a plea of guilty or nolo contendere to, regardless of adjudication, to a felony under 21 U.S.C. ss. 801-970 (relating to controlled substances) or 42 U.S.C. ss. 1395-1396 (relating to public health, welfare,

Medicare and Medicaid issues)?

3.

4.

5.

If you responded “No” to the question above, skip to question 3.

a.

Yes

No If “Yes” to 2, were you arrested or charged for the felony or felonies after July 1, 2009?

b. Yes No If “Yes” to 2, has it been more than 15 years before the date of application since the sentence and any subsequent period of probation for such conviction or plea ended?

Yes No Have you ever been terminated for cause from the Florida Medicaid Program pursuant to Section 409.913, Florida Statutes?

If you responded “No” to the question above, skip to question 4.

 

Yes

No If you have been terminated but reinstated, have you been in good standing with the

 

 

Florida Medicaid Program for the most recent five years?

Yes

No

Have you ever been terminated for cause, pursuant to the appeals procedures

 

 

established by the state, from any other state Medicaid program?

If you responded “No” to the question above, skip to question 5.

a. Yes No Have you been in good standing with a state Medicaid program for the most recent five years?

b. Yes No Did the termination occur at least 20 years before to the date of this application?

Yes No Are you currently listed on the United States Department of Health and Human Services' Office of Inspector General's List of Excluded Individuals and Entities?

DH-MQA 5022 06/18, Rule 64B9-15.0035, FAC

Page6

7.

Confidential and Exempt from Public Records Disclosure

Pursuant to Sec. 466 [42 U.S.C. 666](a), the department is required and authorized to collect Social Security Numbers relating to applications for professional licensure. Additionally, section 456.013(1)(a), Florida Statutes, authorizes the collection of Social Security Numbers as part of the general licensing provisions. This information is exempt from public records disclosure.

Last Name:

First Name:

Middle Name:

Social Security Number:

(Input with dashes)

Social Security Information - * Under the Federal Privacy Act, disclosure of Social Security numbers is voluntary unless specifically required by federal statute. In this instance, Social Security numbers are mandatory pursuant to Title 42 United States Code, Sections 653 and 654; and Section 456.013(1), 409.2577 and 409.2598, Florida Statutes. Social Security numbers are used to allow efficient screening of applicants and licensees by a Title IV-D child support agency to ensure compliance with child support obligations. Social Security numbers must also be recorded on all professional and occupational license applications and will be used for license identification pursuant to the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (Welfare Reform Act. 104 Pub.L. Section 317) Clarification of the SSA process may be reviewed at www.ssa.gov or by calling 1-800-772-1213.

Board of Nursing

4052 Bald Cypress Way, Bin # C02

Tallahassee, Florida 32399-3252

Phone: (850) 245-4125 Fax: (850) 617-6460

Website: www.floridasnursing.gov

DH-MQA 5022 06/18, Rule 64B9-15.0035, FAC

Page7

NAME

8. HEALTH HISTORY (Supporting documentation should be sent directly to the board office.)

A. Yes No

B. Yes No

Do you have any condition that currently impairs your ability to practice your profession with reasonable skill and safety?

Are you using medications, other drugs, narcotics, or intoxicating chemicals that impair your ability to practice your profession with reasonable skill and safety?

.

If you answered “Yes” to any of the questions in this section, you are required to send the following items:

Please provide a letter from a licensed health practitioner, who is qualified by skill and training to address your condition, which explains the impact your condition may have on your ability to practice your profession with reasonable skill and safety, and stating either that you are safe to practice your profession without restriction or indicating what restrictions are necessary. If necessary, you may

attach additional sheets.

Documentation must be current within the last year.

If you fail to disclose the information requested in this section, your application may be denied.

Self Explanation, explaining the medical condition(s) or occurrence(s) and current status.

DH-MQA 5022 06/18, Rule 64B9-15.0035, FAC

Page8

Document Specifications

Fact Name Details
Application Completion It's essential to fill out every section of the application completely. Incomplete applications will lead to delays.
Active Certification Applicants must provide proof of an active CNA certification that is clear and in good standing from their state.
Fingerprint Requirement All applicants are required to submit electronic fingerprints using an approved Livescan provider. This includes verifying via Florida Department of Law Enforcement guidelines.
Criminal History Disclosure Disclosure of all criminal offenses is mandatory. Failure to report may lead to application denial.
Documentation for Disciplinary Action If you have a history of license denial or disciplinary actions, you must provide a detailed explanation and relevant documentation.
Application Notification You must inform the Board in writing of any changes to your application status or personal information that occurs after submission.
Governing Laws This application is governed by Florida Statutes, particularly Section 456.0635(2), and Rule 64B9-15.0035, FAC.

Steps to Filling Out Cna License To Florida

Completing the Certified Nursing Assistant (CNA) License to Florida form is a critical step toward obtaining your licensure. Careful attention to detail will help avoid delays in processing. Once you have filled out the form and gathered all necessary documents, you will submit everything to the appropriate state department for review.

  1. Gather Required Information: Collect your personal details, including your full name, date of birth, mailing address, and contact numbers.
  2. Complete Personal Information Section: Fill out all fields in the personal information section accurately. This includes your address, telephone numbers, and, if desired, the option for email notifications regarding your application status.
  3. Applicant Background: Provide any other names you have used and your education details. Answer questions regarding prior application attempts in Florida and disclose information about any previous licenses.
  4. Criminal History Disclosure: Carefully answer any questions regarding past convictions or legal issues. If applicable, prepare to submit detailed documentation, including self-explanations and final disposition records.
  5. Proof of Certification: Ensure you have proof of active certification. This documentation must show that your out-of-state certificate is in good standing.
  6. Confidential and Exempt from Public Records Disclosure Form: Complete and include this form, which should be enclosed with your application.
  7. Fingerprint Submission: Schedule your Livescan fingerprinting through an approved provider. Keep a record of your submission, as it is required as part of your application.
  8. Review Application: Thoroughly go through the application to make sure that all questions are answered honestly and completely. Double-check for accuracy.
  9. Mail Your Application: Send the completed application, along with all supporting documents, to the Department of Health, Certified Nursing Assistant Registry at the provided Tallahassee address.
  10. Update Notification: Remember to inform the Board in writing of any changes to your application details after submission.

After receiving your completed application, the Board will process it in the order it was received. It is essential to keep records of your submissions and any correspondence to stay updated. Wait for further communications regarding your application's status and additional steps, if necessary.

More About Cna License To Florida

What is the process for applying for a CNA license in Florida?

To apply for a Certified Nursing Assistant (CNA) license in Florida, you need to complete an application in its entirety and submit it to the Department of Health. Be sure to answer all questions honestly. You'll also need to provide proof of active certification, submit a Livescan fingerprint, and include a Confidential and Exempt from Public Records Disclosure Form. Incomplete applications will cause delays.

What documents do I need to include with my CNA application?

Your application must include several important documents. First, ensure you attach proof of your active certification from another state. You also need to submit a completed Livescan fingerprint record, the Confidential and Exempt from Public Records Disclosure Form, and any documentation related to criminal or disciplinary history if applicable. All documents submitted become part of your permanent record.

What happens if I fail to disclose criminal history on my application?

If you do not disclose your criminal history, you risk having your application denied. Each application is reviewed individually, but honesty is crucial. Minor traffic offenses typically do not count, but all other offenses must be reported. If you have a significant history, you may need to provide additional documentation, including letters of recommendation and explanations.

Can I withdraw my CNA application after submission?

Yes, you can withdraw your application, but it must be done in writing. Ensure your request is received by the Board before they begin the review process. Once your application has been reviewed, it may not be possible to withdraw at that stage.

How will I be notified about the status of my application?

If you would like to receive email notifications regarding your application status, you should indicate that on your application and provide your email address. However, be aware that email addresses are public records in Florida. If you prefer not to have your email disclosed, consider opting for phone or mail communication instead.

What should I know if I have previously been denied a license?

Applicants who have been denied a license in any jurisdiction must disclose that information and provide a self-explanation. Failure to report this can lead to denial of your application. Ensure that relevant boards submit all necessary documentation directly to the Florida Board of Nursing.

Is there a timeline for application processing?

Applications are reviewed in the order they are received, so it is essential to submit a complete application promptly. The processing time may vary, but any inaccuracies or missing information can significantly delay the process. Keep all records updated, especially if any information changes after submission.

Common mistakes

  1. Failing to Sign the Application: It is crucial to sign the application. An unsigned application will be considered incomplete and will lead to delays.

  2. Leaving Questions Blank: Every question needs an answer. Omitting information can cause the Board to delay processing your application or even deny it.

  3. Providing Inaccurate Information: Honest answers are important. Misinformation may result in denial of your application.

  4. Not Including Proof of Active Certification: Ensure your out-of-state certification is clear and active. Without this proof, your application may be rejected.

  5. Neglecting Livescan Fingerprinting: All applicants must submit fingerprints electronically through a Livescan provider. Failing to do so will result in application denial.

  6. Ignoring Updates to Your Application: If any details about your application change, notify the Board in writing. Failure to do so could delay or complicate your application process.

  7. Overlooking Criminal History Disclosure: All criminal offenses, not just serious ones, should be disclosed. Not doing so could jeopardize your application.

  8. Forgetting Required Documentation: Applicants must submit specific documents regarding any criminal history and disciplinary actions. Missing these documents often leads to delays.

Documents used along the form

Applying for a Certified Nursing Assistant (CNA) license in Florida involves submitting several important documents along with your application. Each of these forms will help ensure that your application is complete and processed efficiently. Here's a list of other forms and documents commonly needed in conjunction with the CNA License to Florida form.

  • Proof of Active Certification: This document verifies that your out-of-state certification is valid and in good standing, which is crucial for your application.
  • Confidential and Exempt from Public Records Disclosure Form: This form protects certain information from being shared publicly, maintaining your privacy during the application process.
  • Livescan Fingerprints: You must submit your fingerprints electronically through a Livescan provider, which is required for background checks conducted by the Florida Department of Law Enforcement.
  • Final Disposition Records: If you have a criminal history, you may need to provide final disposition records from the clerk of the court detailing past convictions or charges.
  • Completion of Probation/Parole Records: If applicable, this document shows that you've fulfilled any probation or parole requirements related to past offenses.
  • Self-Explanation Letter: Applicants with a criminal history will need to provide a personal letter explaining the circumstances surrounding any listed offenses.
  • Letters of Recommendation: Typically, you’ll need 3-5 letters from colleagues or supervisors attesting to your professional character and experience, especially if you have a criminal history.
  • Disciplinary History Documents: If you've faced disciplinary actions or denied licenses in other states, you must provide documentation regarding these incidents.
  • Withdrawal Request: Should you choose to withdraw your application, a written request must be submitted prior to the Board’s review.
  • Application Update Notification: If there are any changes that impact your application, such as an address change or legal issues, you must notify the Board in writing.

It's essential to gather and prepare all necessary forms to avoid delays in your application process. Be thorough and honest in your submissions, as each document plays a vital role in demonstrating your qualifications and fitness for licensing as a CNA in Florida.

Similar forms

The Certified Nursing Assistant (CNA) application process closely resembles the Nurse Licensure Application. Both documents require applicants to provide personal information, answer questions regarding their background, and submit proof of active licensure from another state if applicable. Each process emphasizes the importance of honesty in answering background questions. Furthermore, both applications require fingerprinting and background checks, ensuring that only qualified individuals can enter the nursing profession. While the focus is on different roles within healthcare, the procedural similarities underscore the regulatory framework of nursing in the U.S.

Another similar document is the Practical Nurse Licensure Application. Like the CNA application, this form necessitates a thorough background check and proof of completed education in nursing. Both applications require applicants to report any past criminal history or disciplinary actions from previous licenses. Additionally, applicants must submit letters of recommendation and a self-explanation if they have any negative history relevant to their licensing. Ensuring applicant integrity and public safety remains a critical component across these applications.

The Registered Nurse (RN) Licensure Application also shares several characteristics with the CNA application. Both documents request comprehensive personal details, including prior names and any other healthcare licenses held. Applications for RN candidates similarly involve proof of education, confirmation of active licensure, and submission of fingerprints. Additionally, applicants are required to disclose any criminal history or disciplinary actions. This consistency in documentation serves to maintain high standards of nursing practice in Florida.

The Home Health Aide License Application mirrors the CNA application in its approach to applicant screening. It requires a completed application with signature, as well as detailed personal information. Both licenses necessitate proof of certification and a background check using Livescan fingerprinting. The honesty requirement is also present in both forms, with ramifications for falsifying information. Given the critical nature of health care, these applications ensure that potential licensees are thoroughly vetted.

The Personal Care Aide License Application shares similar requirements with the CNA form, including a detailed checklist to confirm submission completeness. Both documents require applicants to disclose any previous names and contact details. A comprehensive criminal history disclosure is similarly mandated in both applications, ensuring that those seeking licensure have been thoroughly vetted. The significance of integrity and public safety remains a strong theme in both licensing processes.

Another relevant document is the Massage Therapy License Application. Like the CNA application, this form requires applicants to provide a complete application, include personal identifiers, and submit proof of education. Each application also includes a background check and the necessity to disclose any criminal conduct. Likewise, both are governed by the same regulatory agency, illustrating the interconnectedness of healthcare licensing in Florida.

The Pharmacy Technician Registration Application also exhibits parallels with the CNA licensing form. Both documents mandate a complete personal history, active proof of any prior licenses, and a thorough background check via fingerprinting. Applicants for both positions are required to provide honest responses regarding any criminal histories, ensuring that only trustworthy individuals are allowed to work in sensitive healthcare roles. Maintaining high standards of integrity is critical across all these applications.

Finally, the Occupational Therapy Assistant License Application resembles the CNA application in its structure and requirements. Both necessitate detailed personal and educational information, background checks, and letters of recommendation. Furthermore, applicants must be forthright about their criminal histories. The stringent application procedures in both fields aim to foster a safe and competent workforce, reflecting the vital nature of care in the health sector.

Dos and Don'ts

Do:

  • Complete the application in its entirety and ensure your signature is included.
  • Provide accurate and honest answers to all questions on the application.
  • Include proof of active certification from another state if applicable.
  • Submit electronically scanned fingerprints through a Livescan provider.
  • Notify the Board in writing if any changes occur after submission of your application.
  • Keep a copy of all submitted documents for your records.

Don't:

  • Leave any questions on the application unanswered.
  • Provide false information on your application.
  • Forget to submit additional documentation if you have a criminal history.
  • Assume that your application will be processed without any additional information required.
  • Withdraw your application without making a written request to the Board.
  • Neglect to follow up if you experience delays in the application process.

Misconceptions

The process of obtaining a Certified Nursing Assistant (CNA) license in Florida can be confusing, and several misconceptions may contribute to misunderstandings. Below is a list of common misconceptions, along with clarifications to help individuals navigate this important process.

  • Misconception 1: The application does not need to be complete before submission.
  • This is false. An incomplete application can lead to delays in processing, so it is crucial to answer every question and submit all necessary documents.

  • Misconception 2: Providing false information on the application will not result in consequences.
  • On the contrary, the Board of Nursing may deny your application if you give false information, so honesty is essential.

  • Misconception 3: Only residents of Florida can apply for the CNA license.
  • Anyone with an active certification from another state can apply. However, proper documentation must be provided.

  • Misconception 4: Fingerprints are not required for the application.
  • The Livescan fingerprinting process is a mandatory part of the application, ensuring thorough background checks.

  • Misconception 5: Criminal history does not need to be disclosed unless it is a serious crime.
  • All misdemeanors and felonies must be reported, regardless of severity. Failure to disclose this information can lead to denial of the application.

  • Misconception 6: You cannot withdraw your application once it is submitted.
  • Applicants can withdraw their application by submitting a written request prior to the Board's consideration.

  • Misconception 7: Letters of recommendation are optional.
  • For applicants with a criminal history, 3-5 letters of recommendation are required to support their application.

  • Misconception 8: The application will be fast-tracked if you submit it in-person.
  • Applications are processed in the order they are received, regardless of the submission method, whether in-person or by mail.

  • Misconception 9: You can keep your email address private by providing it on the application.
  • Under Florida law, email addresses are public records. If you wish to maintain privacy, consider communicating by phone or mail instead.

Understanding these misconceptions can help streamline the application process and pave the way for a successful career as a Certified Nursing Assistant in Florida.

Key takeaways

When filling out and using the CNA License To Florida form, keep the following key takeaways in mind:

  • Complete Your Application: Ensure that you fill out every question on the application honestly. Incomplete or misleading information can lead to delays or even denial of your application.
  • Active Certification Required: If you are applying from another state, your certification must be clear, active, and in good standing. This status is crucial for a smooth application process.
  • Fingerprinting is Mandatory: All applicants must submit electronic fingerprints through an approved Livescan provider. Without this, your application cannot be processed.
  • Report All Criminal History: List any past convictions or guilty pleas, even for minor offenses. Failing to disclose this information can impact your eligibility.
  • Notify of Changes Promptly: If your personal information changes after submitting your application, alert the Board in writing. This includes changes to your name, address, or any legal matters.