Navigating the landscape of professional certifications can often seem like a maze, filled with various forms, deadlines, and procedures. Among these, the Form 1402 OK emerges as a critical document for candidates seeking to undertake testing and registry through D&S Diversified Technologies LLP, trading as HEADMASTER LLP. This form facilitates a streamlined process for individuals aiming to schedule their examinations, whether they're approaching their initial application or gearing up for a retest. Required for a broad spectrum of candidates, the form outlines specifics regarding testing dates, site selection (including fixed regional sites and approved flexible sites for in-facility training programs), as well as detailed rate structures for different types of tests and services. The process delineated ensures that applicants can choose their preferred test locations and dates, simultaneously accommodating those who require ADA accommodations. Notably, it also addresses financial transactions and the potential for reimbursement for those currently employed as nurse aides in facilities partially funded by OKDH, highlighting a thoughtful consideration for the candidates' contexts. With a keen focus on accessibility, the form includes options for web-based submissions through Webetest, alongside traditional mailing routes, ensuring that every candidate can navigate the application process with ease.
| Question | Answer |
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| Form Name | Form 1402 Ok |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | 2005, OSDH, dba, 1st |
D&S DIVERSIFIED TECHNOLOGIES LLP dba HEADMASTER LLP
PO BOX 6609 HELENA MT 59604
TELEPHONE:
EMAIL: hdmaster@hdmaster.com
WEB SITE: www.hdmaster.com
TESTING AND REGISTRY APPLICATION RATE STRUCTURE
DIRECTIONS
1.Do not need to fill out this form if you are using Webetest
2.Mail completed forms at least 10 working days prior to requested test date
3.Complete one Form 1402OK (this form) for each group of Candidates
4.For initial applications include one Form 1101OK (CNA application) for each candidate
5.For retest applications include Form 1301OK (test results) for each candidate
OPTION 1 FIXED Test Dates - Candidates that must use Fixed (Regional) Test sites
1st Choice |
Test Site Name____________________________ 4 Digit Test Site # ______________Test Date________________ |
2nd Choice |
Test Site Name____________________________ 4 Digit Test Site # ______________Test Date________________ |
OPTION 2 Approved Flexible Test Sites – Only
Name of Test Site ________________________________________________ Date test will be given _______/________/_______
Email ________________________________________ Phone (______)
Address __________________________________________________ City __________________ State __________ ZIP ___________
Name Test Observer ________________________________________ Contact Person’s Name ______________________________
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For ADA Accommodations attach authorization from OSDH. |
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Tests / Service |
# Requested |
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Total |
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Candidate |
Cost |
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PRIORITY FAX SERVICE (Optional) Fax |
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Written Test |
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$20.00ea |
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Applications will be processed and test confirmation letters mailed |
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Oral Test |
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$35.00ea |
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on the day the applications are received by fax OPTIONAL |
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Skill Test |
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$75.00ea |
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EXPRESS Overnight SERVICE: Application(s) must be received |
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five workdays prior to 1st requested test date. An additional $15 |
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Priority Fax Service |
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$5.00ea |
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per candidate plus express overnight shipping charge of $19.50 |
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Overnight Shipping |
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$19.50 |
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apply. (No additional Fax charges apply) If you fax in your |
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Express Service Fee |
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$15.00ea |
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application please do not mail the original. WEBETEST© High |
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Volume users Internet electronic application submission. |
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No Show |
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No |
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Call |
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Refund |
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Reschedule |
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$35.00 |
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CHECKS. Candidates may ONLY send cashiers check, money |
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order, or use Visa/MC. Mail to PO Box 6609 Helena, MT 59604. |
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Cancellation |
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$25.00 |
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Grand Total Enclosed $_________ |
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If Facility paid then Facility name and address_____________________________________________________________________
Credit Card # (Visa, MC)___________________________________________________Expiration Date ___________/___________
Name as it appears on credit card ________________________________ Authorized Signature __________________________
Candidates CURRENTLY EMPLOYED, AS NURSE AIDES IN SKILLED MEDICARE/MEDICAID FACILITIES THAT ARE PARTIALLY REIMBURSED BY OKDH DO NOT INCLUDE FULL PAYMENT. Please call OKDH for questions about reimbursement status. Must list the Name and Location of the reimbursed Facility
Facility name and address_____________________________________________________________________________________________________
Phone (______)
The submission of this application certifies that Testing Services are requested for the candidates included. D&SDT is hereby authorized to proceed with testing and the applicant(s) understand(s) and agree(s) to abide by D&SDT testing, retesting, scheduling, rescheduling, cancellation, and No show policies.
Authorization Signature________________________________ Print Name_________________________________Phone (_____)
FORM 1402 OK |
Updated: 11/16/2005 |