Cna Employment Verification Tx Details

Texas Form 5506 NAR is used to report the sale or exchange of certain types of property. This form must be filed within 30 days after the date of the sale or exchange. The information reported on this form can help you avoid paying taxes on the property you sell or exchange. Read on to learn more about Texas Form 5506 NAR and how to file it.

This information can help you understand better the details of the texas form 5506 nar before you start filling it out.

QuestionAnswer
Form NameTexas Form 5506 Nar
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namestexas nurse aide renewal form, cna renewal form, nurse aide registry texas, cna renewal forms application

Form Preview Example

 

Form 5506-NAR

Texas Nurse Aide Registry

March 2018-E

 

Employment Verification

Please complete document in blue ink only.

Section 1. To be completed by Nurse Aide - Please read the following instructions before completing this form.

The Nurse Aide Registry has implemented a new online system called Credential Manager. Before completing this form, you are required to verify your information in the new system at: https://i7lp.integral7.com/txna. Click on "Up For Renewal but Never Logged In" and complete your registration. Once you have registered, please list your identification number here:

I.D. No.:

Complete all information in Section 1 and sign to verify that the information provided is correct.

Attach a legible photocopy of a picture identification that shows your birth date and the correct spelling of your name.

Obtain employer verification (Section 2). Form must be mailed to: Texas Nurse Aide Registry, P.O. Box 149030, Mail Code E-414, Austin, TX

78714-9030. Faxes and copies will not be processed. To verify your Certified Nurse Aide (CNA) number, use the following link: https://emr.dads.state.tx.us/DadsEMRWeb/.

Note: A list of approved in-service education programs can be found at: https://hhs.texas.gov/nar-cbts or https://hhs.texas.gov/nar-approved- inservice

The Texas Nurse Aide Registry will return (without action) incomplete requests and requests without the required documents.

Name of Applicant (Last, First, Middle)

 

 

 

Maiden Name (if applicable)

 

 

 

 

 

 

Mailing Address (Street or P.O. Box)

 

 

 

 

 

 

 

 

 

 

City

State

ZIP Code

Daytime Area Code and Telephone No.

 

 

 

 

 

Social Security No.

Sex

 

Date of Birth (mm/dd/yyyy)

Email Address

 

Male

Female

 

 

 

 

 

 

 

 

CNA Certificate No.

 

 

 

 

 

 

 

 

 

 

 

Verification of requirements for Nurse Aide Recertification

Are you listed on the Employee Misconduct Registry (EMR) as unemployable?

Have you been found to have a conviction of a criminal offense listed in Texas Health and Safety Code, §250.006? If yes, give date of conviction.

Yes Yes

No No

Have you completed 24 hours of in-service education in the past two years?

Yes

No

Note: In-service education requirements are subject to audit. Be prepared to submit in-service certificates if contacted by Texas Health and Human Services Commission (HHSC).

Signature – Nurse Aide

Date

Section 2. To be completed by the Employer - Instructions:

This section must be completed by the facility program director, official keeper of records or actual employer.

Notarize employer signature at the bottom of this section and return to nurse aide.

Employer Name or Company Name

Mailing Address (Street or P.O. Box)

City

 

 

Daytime Area Code and Telephone No.

State

ZIP Code

 

 

I certify that the individual named above is/was employed by me as a nurse aide and performed nursing/nursing-related services

from (mm/dd/yyyy)

 

 

to (mm/dd/yyyy)

 

 

 

 

 

and that I am not aware of any disqualifying misconduct.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Comments:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature – Employer

 

 

 

 

 

 

 

 

 

 

Date

 

Sworn and subscribed to me on this

 

day of

 

 

, 20

 

,

 

 

in

 

 

County, in the state of

 

 

.

 

 

 

 

 

Place Notary Seal or Stamp Here

Signature – Notary Public

Date Commission Expires

Tampering with or attempting to falsify a government record as such a nurse aide certificate is a third-degree felony punishable by up to 10 years in prison and a $10,000 fine.

Form 5506-NAR

Page 2 / 3-2018-E