Washington State Department of Health Nursing Assistant Registration Online Application
This file provides step-by-step instructions and a checklist for applying for Nursing Assistant Registration online with the Washington State Department of Health. It includes important background check information, application fees, and necessary documentation.
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How do I fill this out?
To fill out this form, you need to follow the provided instructions carefully, ensuring all required fields are completed accurately. Ensure you have all necessary documents ready to avoid delays. Follow the steps outlined to submit your application online or via mail.
How to fill out the Washington State Department of Health Nursing Assistant Registration Online Application?
1
Collect all necessary documents and information.
2
Fill out the online application form with your personal and demographic information.
3
Pay the application fee using a debit or credit card or ACH/E-Check.
4
Submit the completed form and any additional documentation via email or mail.
5
Wait for an email notification regarding your application status.
Who needs the Washington State Department of Health Nursing Assistant Registration Online Application?
1
Individuals applying for Nursing Assistant Registration in Washington State.
2
Applicants who need to complete a fingerprint-based background check.
3
Individuals who have lived in another state or have a criminal record in Washington State.
4
Military personnel or their spouses seeking expedited health professional licenses.
5
Health care professionals needing a National Provider Identifier (NPI) number.
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Fill in the required fields with your personal and demographic information.
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Save and download the edited PDF for submission.
What are the instructions for submitting this form?
Submit your completed form and any additional documentation by email to hsqacredentialingintake@doh.wa.gov or by mail to Department of Health, PO Box 47877, Olympia WA 98504-7877. For questions or assistance, contact the customer service center at 360-236-4700 or hsqa.csc@doh.wa.gov. Ensure all required fields are completed and all necessary documents are included to avoid delays in processing.
What are the important dates for this form in 2024 and 2025?
There are no specific important dates for this form in 2024 and 2025. However, applicants should ensure timely submission of their forms to avoid any delays in processing.
What is the purpose of this form?
The purpose of this form is to facilitate the online application process for Nursing Assistant Registration with the Washington State Department of Health. The form provides detailed instructions, background check information, and a checklist of required documentation. It aims to streamline the application process and ensure applicants provide all necessary information for timely processing.
Tell me about this form and its components and fields line-by-line.
- 1. Social Security Number: A valid social security number is required to apply online.
- 2. Legal Name: Provide your full legal name, including first, middle, and last names.
- 3. Birth date: Enter your birth date including the month, day, and year.
- 4. Birth place: Indicate the city, state, and country where you were born.
- 5. Address: List the address where you want to receive information about your credential.
- 6. Phone, Fax, and Cell Numbers: Include your phone, fax, and cell numbers with area codes.
- 7. Other Name(s): Specify any other names you are known by or have used in the past.
- 8. Other Licenses, Certifications, or Registrations: Indicate if you have held any other licenses, certifications, or registrations in another state.
- 9. Personal Data Questions: Answer all personal data questions. If any answers are 'yes', submit a paper application.
- 10. Military Information: Provide details about any military training or spousal status for expedited processing.
- 11. National Provider Identifier Number: Provide your NPI number if you have one.
- 12. AIDS Education and Training Attestation: Confirm completion of the required AIDS education and training.
- 13. Applicant's Attestation: Agree to the applicant's attestation to continue with the application.
What happens if I fail to submit this form?
Failure to submit this form may result in delays in processing your application. Ensure all information is complete and accurate to avoid any issues.
- Delayed Processing: Incomplete submissions can cause delays in the processing of your application.
- Missing Documentation: Failure to provide required documentation may result in a rejected application.
- Invalid Information: Submitting inaccurate information can lead to application denial.
How do I know when to use this form?
- 1. Initial Application: Use this form for your initial Nursing Assistant Registration application.
- 2. Credential Renewal: Complete this form to renew your Nursing Assistant credential.
- 3. Information Update: Use this form to update your personal or demographic information with the Department of Health.
- 4. Military Expedited Processing: Submit this form for expedited processing if you are military personnel or a spouse of military personnel.
- 5. Out-of-State Verification: Use this form to verify credentials from other states.
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