Candidate Information Name Available: Register for Free Title Nurse Aide Continuing Education Target Location US-MI-Sterling Heights Email Available with paid plan Phone Available with paid plan	20,000+ Fresh Resumes Monthly     View Phone Numbers     Receive Resume E-mail Alerts     Post Jobs Free     Link your Free Jobs Page     ... and much more Register on Jobvertise Free
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Application for Nurse Aide RegistrationFirst Name Middle Initial Last Name Previous NameCandidate's Name
Date of Birth Last 4 Digits of Social Security Number Street Address /06/1989Street AddressStreet Address  hickory dr aptACity State Zip CodeSterling Heights Michigan 48312Phone NumberPHONE NUMBER AVAILABLEEmail AddressEMAIL AVAILABLECountyKentApplicant InformationRegistration Option[ ] New Registration (You have completed training and testing requirements in Michigan and would like to receive registration as a nurse aide.)[X] Reciprocity (You have trained and tested in one of the Michigan approved states AND you are currently active and in good standing on any states nurse aide registry.) StateIllinoisRegistration NumberNAIs the status of your registration in this state currently active?[X][ ]YesNoIs your registration in this state currently in good standing with no substantiated allegations of abuse, neglect, or misappropriation?[X][ ]YesNoReciprocity DetailsPay and SubmitE-SIGNATUREBy submitting my electronic application and entering my name below, I certify: All information provided in this document is true and correct to the best of my knowledge. I meet and will follow any applicable federal regulations, state regulations, and administrative rules. I understand that: Effective March 23, 2026, I must attest to completing at least 12 hours annually of continuing education within my renewal period in accordance with Rule 400.315. I must retain documentation demonstrating that I have completed a course/training that is relevant to nursing services and including, but not limited to, abuse, neglect, or care planning. The documentation must include the course name, location, hours of course, topic, and date completed to demonstrate compliance with Rule 400.315, if requested by the department for auditing purposes. I understand that a false statement or dishonest answer by me may be grounds for disciplinary action against my permit/registration or may be punishable by law. I understand that I am prohibited from employment in a covered facility under the Michigan Public Health Code if I have had a substantiated finding against me for abuse, neglect, and/or misappropriation of resident property. I understand that there is a non-refundable application fee of $40.00. First NameMenaLast NameIsmael[X] AcceptSubmitted 03/12/2024 02:44 PM