Edit, Download, and Sign the CNA Recertification Application Form

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How do I fill this out?

To fill out the CNA recertification application form, begin by providing your personal information, including your name and contact details. Next, ensure you have the required documentation ready, such as your current CNA certificate and a valid ID. Finally, complete the payment details as required before submitting the application.

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How to fill out the CNA Recertification Application Form?

  1. 1

    Gather your personal information.

  2. 2

    Prepare required documents like your CNA certificate.

  3. 3

    Fill out each section of the form accurately.

  4. 4

    Verify that all information is correct.

  5. 5

    Submit the application along with the payment.

Who needs the CNA Recertification Application Form?

  1. 1

    Individuals looking to renew their CNA license need this form to prove their qualifications.

  2. 2

    Employers may require their employees to complete this application for compliance purposes.

  3. 3

    Healthcare professionals who wish to maintain their certification should use this form.

  4. 4

    Students of CNA programs must submit this application upon completion of their training.

  5. 5

    Anyone wishing to update personal information related to their CNA certification must fill out this form.

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    Open the CNA recertification application in PrintFriendly.

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    Click on the fields to edit your information.

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What are the instructions for submitting this form?

Submit your completed CNA recertification application form via mail to Professional Healthcare Educators, located at 1286 Kalani St. B-204, Honolulu, Hawaii 96817. You may also email scanned copies to info@phe-hawaii.com. For urgent matters, consider faxing your application to (808) 847-3366. Ensure that payment details are included for processing.

What are the important dates for this form in 2024 and 2025?

Important dates for submission of the CNA recertification application in 2024 include January 1 for the first quarter and April 1 for the second quarter. Ensure your application is submitted prior to these dates for timely processing. Keep an eye out for any changes in renewal periods in 2025.

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What is the purpose of this form?

The purpose of the CNA recertification application form is to ensure that individuals meet the necessary criteria to maintain their certification. It serves as a formal request to the regulatory body for the renewal of the CNA license. By filling out this form accurately, applicants affirm their qualifications and commitment to standards in the healthcare field.

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Tell me about this form and its components and fields line-by-line.

The form consists of various fields to gather essential information for recertification.
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  • 1. Student Information: Includes personal details like name, address, and contact information.
  • 2. CNA License Information: Contains fields for CNA license number and expiration date.
  • 3. Payment Details: Section for detailing tuition fees and payment methods.
  • 4. Requirements Acknowledgment: Confirms that the applicant meets all listed requirements.
  • 5. Signature: Area for the applicant's signature and date.

What happens if I fail to submit this form?

Failing to submit this application form may result in the lapse of your CNA certification, preventing you from legally working as a CNA. It's critical to ensure that the form is filled out completely and accurately to avoid delays. Regular follow-up on the status of your application is recommended.

  • Lapsed Certification: If the application is not submitted on time, you risk losing your certification.
  • Regulatory Non-Compliance: Failure to apply may lead to issues with state compliance regulations.
  • Employment Risks: An unsubmitted application can jeopardize your current employment in healthcare.

How do I know when to use this form?

You should use this CNA recertification application form as your current license approaches expiration or when you change your personal information. It is also necessary if you have recently completed additional training and need to update your records. Additionally, use this form if you're transitioning employment and need to maintain your certification.
fields
  • 1. License Renewal: Utilize this form to renew your CNA license before expiration.
  • 2. Personal Information Update: Submit when changes in your address or status occur.
  • 3. After Training Completion: Required upon completion of further education in the nursing assistant field.

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What happens if my application is incomplete?

An incomplete application may delay processing and can result in additional follow-up measures.

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You should receive a confirmation once your application is processed.

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Is there a fee associated with this application?

Yes, there is a fee of $125.00 required at the time of registration.

How long does the processing take?

Processing times can vary, but you will be notified of any updates or delays.

What if I make a mistake on the form?

If you notice an error, you can edit the PDF again before finalizing your submission.

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