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LICA NA REV  Page CALIFORNIA BOARD OF REGISTERED NURSING GENERAL INSTRUCTIONS AND APPLICATION LICA NA REV  Page CALIFORNIA BOARD OF REGISTERED NURSING GENERAL INSTRUCTIONS AND APPLICATION

LICA NA REV Page CALIFORNIA BOARD OF REGISTERED NURSING GENERAL INSTRUCTIONS AND APPLICATION - PDF document

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Uploaded On 2015-03-17

LICA NA REV Page CALIFORNIA BOARD OF REGISTERED NURSING GENERAL INSTRUCTIONS AND APPLICATION - PPT Presentation

General Application Requirements Nurse Anesthetist certification eligibility requires the possession of a current clear and active California RN license The following must be submitted to the Board of Registered Nursing for Nurse Anesthetist certifi ID: 46823

General Application Requirements Nurse

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*(1(5AL I1S758C7I21S C217¶' 1aPe and/Rr Address CKangesCode of Regulations, Section 1409.1 requires that you notify the Board of Registered Nursing of all name and address changes within thirty (30) days of any change. You may call the Board of Registered Nursing regarding the change of address of record. If you have changed your name, please submit a letter of explanation regarding the requested name change plus applicable documentation such as a copy of a marriage certificate, divorce decree or a driver’s license. 8S SRciaO SecXrit\ and IndiYidXaO 7a[Sa\er I' 1XPEer 'iscORsXre Rf \RXr 8S SRciaO SecXrit\ 1XPEeris PandatRr\ Section 30 of the Business and Code and Public Law 94-455 (42 USCA 405 (c)(2)(C)) authorize collection of your 8S Swill be used exclusively for tax enforcement purposes, for purposes of compliance with any judgment or order for family support in accordance with Section 11350.6 of the Welfare and Institutions Code, or for verification of licensure, certification or examination status by a licensing or examination entity h utilizes a national examination and where licensure is reciprocal with the requesting state. If \RX faiO tR discORse \RXr 8S SRciaO SecXrit\ 1XPEer/I7I1 \RXr aSSOicatiRn fRr initiaO Rr reneZaO Rf OicensXre/ certificatiRn ZiOO nRt Ee SrRcessed generaOO\ OaZ enfRrcePent agencies@ ZKeneYertKe Pandated reSRrter in Kis Rr Ker SrRfessiRnaO caSacit\ Rr ZitKin tKe scRSe Rf Kis Rr KerePSOR\Pent Kas NnRZOedge Rf Rr REserYes a cKiOd ZKRP tKe Pandated reSRrter NnRZs RrreasRnaEO\ sXsSects Kas Eeen tKe YictiP Rf cKiOd aEXse Rr negOect 7Ke Pandated reSRrter PXst PaNe a reSRrt tR tKe agenc\ iPPediateO\ Rr as sRRn as is SracticaEO\ SRssiEOe E\ teOeSKRne andtKe Pandated reSRrter PXst SreSare and send a Zritten reSRrt tKereRf ZitKin 6 KRXrs Rf receiYingtKe infRrPatiRn cRncerning tKe incident )aiOXre tR cRPSO\ ZitK tKe reTXirePents Rf SectiRn 66 is a PisdePeanRr SXnisKaEOe E\ XS tRsi[ PRntKs in a cRXnt\ MaiO E\ a fine Rf Rne tKRXsand dROOars 000  Rr E\ ERtK iPSrisRnPent and fine )Rr fXrtKer detaiOs aERXt tKese reTXirePents cRnsXOt 3enaO CRde SectiRn 6 and sXEseTXent sectiRns If \RX dR nRt SRssess a cXrrent cOear and actiYe CaOifRrnia 51 Oicense and KaYe neYer aSSOied fRr a CaOifRrnia 51 Oicense an ASSOicatiRn fRr CaOifRrnia 51 LicensXre E\ (ndRrsePent PXst aOsR Ee 1A 5(9