Florida Certified Nursing Assistant Examination Application
This document is the application and instructions for the Florida Certified Nursing Assistant Examination. It includes important information and guidelines for completing the form. Ensure all fields are filled out correctly to avoid delays in processing.
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How do I fill this out?
To fill out this form, you need to provide accurate and complete information as requested. Ensure that your name matches the name on your government-issued ID exactly. Review your responses for accuracy and completeness before submission.
How to fill out the Florida Certified Nursing Assistant Examination Application?
1
Visit the specified Prometric website to access the current version of the application.
2
Fill out all required fields with accurate and complete information.
3
Include the Payment Form at the end of the application.
4
Submit any additional required documentation such as legal name change documents.
5
Mail the completed application and documents to the provided address.
Who needs the Florida Certified Nursing Assistant Examination Application?
1
Nursing assistant candidates looking to get certified in the state of Florida need this application to register for their examination.
2
Individuals who have had a name change since their last nurse aide exam must submit this form with appropriate documentation.
3
Candidates requiring ADA accommodations for the examination must complete and submit this form along with the ADA packet.
4
People with previous CNA examination attempts in Florida after 2002 need to fill out this form.
5
Applicants who need to disclose any criminal or disciplinary history must provide details using this form.
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What are the instructions for submitting this form?
Submit the completed application along with the Payment Form and any additional documents to Prometric, ATTN: FL Nurse Aide Program, 7941 Corporate Drive, Nottingham, MD 21236. For online submissions, use the provided Prometric website forms. Include your email address for processing updates. Our advice is to double-check all documents and information for accuracy and completeness before submission to avoid any delays.
What are the important dates for this form in 2024 and 2025?
Check for important dates such as application submission deadlines and examination dates for 2024 and 2025 on the Prometric website.
What is the purpose of this form?
The purpose of this form is to apply for the Florida Certified Nursing Assistant (CNA) Examination and provide necessary details for processing. It gathers personal, contact, legal history, and other relevant information needed for eligibility and scheduling of the CNA exam. Completing this form accurately and submitting required documentation ensures a smooth application process and timely scheduling of the examination.
Tell me about this form and its components and fields line-by-line.
- 1. First Name: Your first name as per your government-issued ID.
- 2. Middle Initial: Your middle initial, if any.
- 3. Last Name: Your last name as per your government-issued ID.
- 4. Date of Birth: Your birth date in MM/DD/YYYY format.
- 5. Previous Name: Provide any previous names if applicable.
- 6. Street Address: Your current street address including Apt. number or P.O. Box if any.
- 7. City: The city you reside in.
- 8. State: The state you reside in.
- 9. ZIP Code: Your postal ZIP code.
- 10. Phone Number: Your contact phone number including the area code.
- 11. Email Address: Your email address, mandatory for processing the application.
- 12. Race: Optional field to indicate your race.
- 13. Gender: Choose your gender: Male or Female.
- 14. High School Diploma: Indicate whether you have a High School Diploma or equivalent.
- 15. Criminal History: Answer the mandatory criminal and Medicaid/Medicare fraud questions.
- 16. Disciplinary History: Provide information on any disciplinary action taken against your certification.
What happens if I fail to submit this form?
If you fail to submit this form correctly, your application for the CNA exam may not be processed.
- Incomplete Submission: Missing information may lead to rejection or delays in processing.
- Name Mismatch: The provided name must match your government ID to avoid exam disqualification.
- Inaccurate Information: Inaccurate or false information can result in application denial or legal consequences.
How do I know when to use this form?
- 1. New Applicants: First-time candidates for the CNA exam.
- 2. Name Change: Candidates who have had a legal name change.
- 3. ADA Accommodations: Applicants requesting testing accommodations under ADA.
- 4. Previous Examinees: Individuals who have previously taken the CNA exam since 2002.
- 5. Disclosure of History: Candidates required to provide criminal or disciplinary history.
Frequently Asked Questions
How do I access the current version of the CNA Exam Application?
Go to www.prometric.com/NurseAide/FL to print the current version of the application.
Can I submit photocopies of the application?
No, you must submit original forms, as photocopies may impact processing.
What happens if the name on my application doesn't match my ID?
You will not be permitted to take the exam and will forfeit any test fees.
Do I need to fill out the ADA Accommodation Request Packet?
Only if you are requesting ADA accommodations. This packet must be submitted with the application.
What should I do if my legal name has changed?
Provide acceptable legal documentation along with your application.
What types of felonies need to be disclosed?
Felonies under specific Florida Statutes related to social assistance, fraudulent practices, drug abuse, controlled substances, and public health issues.
Do I need to include disciplinary history?
Yes, if you have had any disciplinary action or surrendered a certification related to healthcare.
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