Oklahoma Board of Nursing Employment Verification Form
The Employment Verification Form is utilized by the Oklahoma Board of Nursing to verify employment details for nurses and AUAs applying for reinstatement, endorsement, licensure, or renewal. The form is divided into two sections: one to be completed by the applicant and the other by the employer. It ensures compliance with Oklahoma Nursing Practice Act and helps in the auditing process.
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How do I fill this out?
To fill out this form, you need to provide information in the relevant sections as instructed. Applicants complete Section I, while employers complete Section II. Ensure all fields are filled out accurately to avoid any issues with your application.

How to fill out the Oklahoma Board of Nursing Employment Verification Form?
1
Complete Section I with your personal and application details.
2
Sign the authorization for the employer to complete Section II.
3
The employer fills out Section II including position titles and employment dates.
4
The employer certifies your working hours and status.
5
Submit the completed form to the ORBS Nurse Portal along with your application.
Who needs the Oklahoma Board of Nursing Employment Verification Form?
1
Nurses applying for endorsement to practice in Oklahoma need this form to verify their employment.
2
Nurses seeking reinstatement of their license must provide this form to confirm their recent work history.
3
Advanced Unlicensed Assistants (AUAs) applying for licensure must use this form to verify their experience in an acute care setting.
4
Nurses undergoing a renewal audit must submit this form with their audit paperwork.
5
Employers of nurses and AUAs need this form to provide necessary employment details for their staff.
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What are the instructions for submitting this form?
Complete and sign the form as instructed. Applicants upload the completed form to the ORBS Nurse Portal. If submitting for a renewal audit, include the form with the completed audit paperwork and send it to the Oklahoma Board of Nursing, 2501 N. Lincoln Blvd, Ste 207, Oklahoma City, OK 73105. Contact the board at (405) 962-1800 or fax (405) 962-1821 for further assistance.
What are the important dates for this form in 2024 and 2025?
For 2024 and 2025, ensure submissions for endorsements, reinstatements, and renewals are completed before the respective deadlines set by the Oklahoma Board of Nursing. Check specific dates with the board to stay compliant.

What is the purpose of this form?
The Employment Verification Form serves as a crucial document for verifying employment details of nurses and Advanced Unlicensed Assistants (AUAs) applying for various licensure processes in Oklahoma. This form ensures that the applicant has met the necessary work experience requirements as mandated by the Oklahoma Nursing Practice Act. It not only aids in the licensing process but also helps maintain the credibility and standards of nursing practice in the state.

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

- 1. Section I: To be completed by the applicant, providing personal and application details.
- 2. Section II: To be completed by the employer, providing employment details, job titles, and certification of hours worked.
- 3. Signature: The applicant’s signature authorizing the employer to provide the necessary employment information.
- 4. Employer’s Certification: The employer certifies the accuracy of the employment details provided and ensures compliance with the Oklahoma Nursing Practice Act.
What happens if I fail to submit this form?
Failing to submit this form can result in delays or denial of your application for licensure, endorsement, or reinstatement. It is important to complete and submit the form promptly.
- Application Denial: Your application could be denied for incomplete or missing information.
- Licensure Delay: Delays in processing your license, causing interruptions in your ability to practice.
- Non-Compliance: Failure to comply with the Oklahoma Nursing Practice Act, potentially leading to disciplinary action.
How do I know when to use this form?

- 1. Endorsement Applications: When seeking to practice nursing in Oklahoma with an out-of-state license.
- 2. Reinstatement Applications: When seeking to reinstate a lapsed nursing license.
- 3. Licensure for AUAs: When Advanced Unlicensed Assistants are applying for a certificate.
- 4. Renewal Audit: When nurses are undergoing an audit for their license renewal.
- 5. Verification of Employment: When employers need to verify employment details for their staff.
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