New Mexico Board Of Nursing PDF Details

The New Mexico Board of Nursing released a new form to be completed by all applicants, RNs, and LPNs. The form is in an effort to improve the quality of nursing care throughout the state. The board encourages all applicants to familiarize themselves with the new requirements. Additionally, nurses are required to complete annual continuing education units (CEUs) in order to maintain their license. Board Director Lou Ann Baca invites nurses "to come get your CEU's from us." There are many different ways for nurses to fulfill their CEU requirements, and the board offers numerous opportunities for learning throughout the year. Nurses are also reminded that they must renew their licenses every two years.

In the list, there's some good information regarding the new mexico board of nursing. There, you'll find the information regarding the document you would like to fill out, such as the assumed time to fill it out along with other particulars.

Form NameNew Mexico Board Of Nursing
Form Length1 pages
Fillable fields0
Avg. time to fill out15 sec
Other namesboard of nursing in new mexico application form, new mexico board of nursing application form, new mexico cna endorsement form, new mexico board of nursing endorsement

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On this _________ day of _______________, 20______, I ___________________________, born on

(Print Name)

________________, swear and affirm as follows:

1.That I allowed my New Mexico License/Certification to expire/lapse. The reason for allowing this to occur is as follows:







Attach additional documents if necessary.

2.Please answer either question A or B below:

a.I attest that I did NOT work any hours/shifts in the State of New Mexico or another compact State, since the date in which my license expired/lapsed: ___________.



b.I attest that I DID work on an expired/lapsed license. __________.


i.Supervisors Name: _____________________________

ii. Supervisors Telephone: (

) ___________________





iii.Supervisors email Address: _____________________________

iv.Number of days/shifts worked in the State of New Mexico since the date in which my license expired/lapsed: __________________________

v.I have attached a list or payroll records of all dates and hours worked at a job related to my license/certificate from this day going back to the date when my license/certificate expired. ___________. (This also needs to be signed by your


3.I understand this attestation as well as any supporting documents need be returned to the NMBON no later than 5 business days following the date of submission of my renewal application. Failure to provide this attestation within the time period required could result in disciplinary action taken towards my New Mexico licensure/certificate ___________.


I swear or affirm that the above and foregoing representations are true and correct to the best of My information, knowledge, and belief.




Print Name



Any misrepresentation on this attestation can lead to disciplinary action and will be forwarded to the Compliance Division for investigation.

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Fill out all of the following segments to complete the template:

board of nursing in new mexico application form spaces to consider

Type in the requested details in the field b I attest that I DID work on an, Initial, i Supervisors Name, ii Supervisors Telephone, iii Supervisors email Address, iv Number of daysshifts worked in, which my license expiredlapsed, v I have attached a list or, Initial, I understand this attestation as, NMBON no later than business days, Initial, I swear or affirm that the above, Print Name, and Signature.

Entering details in board of nursing in new mexico application form step 2

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