Lvn Renewal Form PDF Details

The Lvn Renewal form serves as a critical document for vocational nurses and psychiatric technicians who seek to renew their licenses through the Board of Vocational Nursing & Psychiatric Technicians in Sacramento, California. This comprehensive application outlines a clear process for renewal, starting with the complete and accurate filling out of the form, determining the renewal fee based on the license's expiration date, and including detailed instructions on payment methods, where a check or money order is preferred. It emphasizes the importance of attaching the nonrefundable fee without sending cash. The form covers personal identification sections, the need to report any name or address changes with appropriate evidence, and the requirement to specify the type of license being renewed—active or inactive. It delves into the specifics of continuing education for those in active status, mandating the completion of 30 hours of continuing education within the last two years. Additionally, it tackles the necessity of disclosing any license discipline by a government agency or criminal convictions, with certain exceptions, and clarifies the fingerprinting requirements for license renewal, ensuring applicants are aware of all conditions to maintain or reactivate their professional status. Applicants are reminded of the severe consequences of including false statements, underscoring the submission's solemnity under the penalty of perjury laws of the State of California.

QuestionAnswer
Form NameLvn Renewal Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesca breeze gov lvn license renewal, bvnpt renewal, http llwww bvnpt ca gov, bvnpt money vocational online

Form Preview Example

BOARD OF VOCATIONAL NURSING & PSYCHIATRIC TECHNICIANS

2535 Capitol Oaks Drive, Suite 205, Sacramento, CA 95833-2945

Phone (916) 263-7800 Fax (916) 263-7855 Web www.bvnpt.ca.gov

APPLICATION FOR RENEWAL OF LICENSE

(ATTACH RENEWAL FEE )

Check One

□Vocational Nurse □ Psychiatric Technician

Renewal application procedures:

1.Complete and sign the application for renewal of license.

2.Determine the appropriate renewal fee due based on the expiration date on your license from the accrued renewal fee schedule at www.bvnpt.ca.gov/accrue2.htm.

3.Attach a check or money order made payable to the BVNPT. This is a nonrefundable fee. DO NOT SEND CASH.

DO NOT WRITE IN THIS SPACE

CA NUMBER

LICENSE NUMBER

4.Mail the application and fee to the above address.

PRINT OR TYPE (DO NOT USE PENCIL)

1. NAME

(LAST)

(FIRST)

(MIDDLE)

 

 

 

 

2. ADDRESS

 

(STREET OR BOX NUMBER)

(APT. NO)

 

 

 

 

3. CITY

 

STATE

ZIP

 

 

 

 

4. BIRTHDATE

(Month/Day/Year)

5. SOCIAL SECURITY NUMBER*

*NOT required but may assist in identifying records

6.TELEPHONE NUMBER Business

( )_________________________________

Home

( )________________________________

7.

LICENSE NUMBER: ____________________________________

LICENSE EXPIRATION DATE: __________________________________________

 

 

 

 

 

8.

IS THIS A NAME CHANGE?

□YES □NO

IS THIS AN ADDRESS CHANGE?

□YES □NO

(Note: Name changes must be submitted with evidence showing your new legal name (e.g., copy of your driver’s license, social security card, divorce decree or marriage certificate).

9. I WISH TO APPLY FOR THE FOLLOWING TYPE LICENSE:

□Inactive (Fee required is the same as fee for an active license)

□Active (Complete the continuing education information below in Section 10)

10.CONTINUING EDUCATION (CE) REQUIREMENT – CHECK ONE OF THE FOLLOWING:

□This is my first renewal. CE is not required on the first renewal.

□I have not completed the 30 hours of CE. Renew my license with an “inactive” status.

□I have completed 30 hours of CE within the last two years. My CE information is: [If additional space is required, please include it on a separate page.]

Course Name: ________________________________________________________________________________ # of Contact Hours: ____

Completion Date: _____________________________________________

Course Provider#: ____________________________

11.SINCE YOUR LAST RENEWAL, HAVE YOU HAD ANY LICENSE DISCIPLINED BY A GOVERNMENT AGENCY OR BEEN CONVICTED OR PLED GUILTY TO ANY CRIME? A conviction must be reported regardless of whether it was an infraction, misdemeanor, or felony, except that you need not report a conviction for a traffic infraction if the fine was less than $300 and the infraction did not involve alcohol or controlled substances. You must, however, disclose any conviction in which you entered a plea of no contest (Nolo Contendere) and any convictions that were subsequently set aside or dismissed pursuant to Sections 1000 or 1203.4 of the Penal Code.

□YES □NO

If “YES”, please attach explanation.

12.HAVE YOU COMPLIED WITH THE FINGERPRINT REQUIREMENT? For licenses expiring after April 1, 2009, fingerprinting is required as a condition of renewal for anyone licensed prior to January 1, 1998 or for whom a record of the submittal no longer exists.

□YES

Check the “yes” box if either 1) you were licensed on or after January 1, 1998 or 2) you were licensed before January 1, 1998 and submitted your fingerprints

□NO

on or after January 9, 2009.

Check the “no” box if you were licensed before January 1, 1998 and did not submit your fingerprints on or after January 9, 2009. If you check “no” your

□N/A

licensewill not be renewed until you comply with the requirement to submit your fingerprints.

Check the “n/a” (not applicable) box if you are renewing a license that expired before April 1, 2009.

13.PLEASE READ CAREFULLY BEFORE SIGNING. False statements included in this application can result in discipline against your license up to and including revocation.

"I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct."

SIGNATURE:_____________________________________________________________________ DATE:________________________________________

56R-18 (10/10)

1

 

How to Edit Lvn Renewal Form Online for Free

Filling out lvn license renewal ca is a breeze. We made our PDF tool to make it convenient and assist you to prepare any form online. Here are a few steps you'll want to stick to:

Step 1: Press the orange "Get Form Now" button on the following web page.

Step 2: Once you've accessed your lvn license renewal ca edit page, you will notice all options you may take regarding your document within the upper menu.

Provide the details required by the application to prepare the document.

portion of gaps in bvnpt money vocational online

In the LICENSE NUMBER LICENSE, IS THIS A NAME CHANGE YES NO IS, Note Name changes must be, certificate, I WISH TO APPLY FOR THE FOLLOWING, Active Complete the continuing, CONTINUING EDUCATION CE, This is my first renewal CE is, Course Name of Contact Hours, Completion Date Course Provider, SINCE YOUR LAST RENEWAL HAVE YOU, YES NO If YES please attach, HAVE YOU COMPLIED WITH THE, anyone licensed prior to January, and YES Check the yes box if either box, put down your information.

bvnpt money vocational online LICENSE NUMBER LICENSE, IS THIS A NAME CHANGE YES NO IS, Note Name changes must be, certificate, I WISH TO APPLY FOR THE FOLLOWING, Active Complete the continuing, CONTINUING EDUCATION CE, This is my first renewal CE is, Course Name of Contact Hours, Completion Date Course Provider, SINCE YOUR LAST RENEWAL HAVE YOU, YES NO If YES please attach, HAVE YOU COMPLIED WITH THE, anyone licensed prior to January, and YES Check the yes box if either blanks to fill

Put down the demanded information while you're within the NO Check the no box if you were, licensewill not be renewed until, NA Check the na not applicable box, PLEASE READ CAREFULLY BEFORE, and including revocation, I declare under penalty of perjury, and SIGNATURE DATE field.

Entering details in bvnpt money vocational online stage 3

Step 3: Select the Done button to save your file. Now it is offered for export to your device.

Step 4: In order to prevent any issues in the long run, try to prepare as much as two or three duplicates of your form.

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