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Navigating the process of transferring a Certified Nursing Assistant (CNA) license to Florida involves a carefully structured application procedure, underscored by the application checklist provided by the Florida Department of Health. The checklist is an essential roadmap designed to ensure that applicants submit a complete and truthful application, thereby avoiding delays or possible denial. Key elements include a fully completed application with the applicant's signature, proof of an active and clear certification from another state, and a livescan for electronic fingerprint submission. Applicants are required to answer every question on the form with honesty, as misleading information may lead to the denial of the application. Additionally, any changes in personal information, criminal history, or disciplinary actions in other states must be openly disclosed to the Board of Nursing. The procedure underscores the state's commitment to the integrity and security of its healthcare system, requiring applicants to provide comprehensive personal and professional background information. This includes a requirement for a Confidential and Exempt from Public Records Disclosure Form, and detailed steps for those with criminal or disciplinary histories to follow, ensuring that the Florida Board of Nursing has all necessary information to make informed licensure decisions. Acknowledging the gravity of healthcare fraud, applicants with certain felonies may face disqualification from licensure, reinforcing Florida's rigorous standards for healthcare professionals.

Document Preview Example

Application Checklist

Please use the following checklist to help ensure your application is complete.

Completed Application with Signature

An incomplete application will delay final approval of that application. All documents become a permanent part of your file and cannot be returned. Applications are reviewed in date order received.

Every question on the application must be answered. Be sure to answer all questions honestly. The Board of Nursing may deny your application if you provide false information on your application.

Proof of Active Certification

Your out-of-state certificate must be Clear/Active and in good standing.

Completed Confidential and Exempt from Public Records Disclosure Form

Form enclosed

Livescan

All applications received must include electronically submitted fingerprints through a Livescan provider. The Department of Health accepts electronic fingerprinting offered by Livescan providers that are approved by the Florida Department of Law Enforcement.

For a list of approved Livescan vendors BOE 'SFRVFOUMZ"TLFE2VFTUJPOTBCPVU-JWFsDBOplease visit our website at: http://www.flhealthsource.gov/background-screening/

Our current ORI number is EDOH4400Z.

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Applications and other additional documents must be mailed to:

Department of Health

Certified Nursing Assistant Registry

4052 Bald Cypress Way Bin# C-02

Tallahassee, FL 32399-3252

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Important Information

Application Updates

The Board office must be notified in writing of anything which changes or affects a response given in your application. Failure to do so could result in the delay of application processing or denial of your application. Examples: change of name, address, telephone number, arrests or convictions, licensure status or disciplinary action in another state, or an incorrect answer to a question.

Withdrawal of Application

If you decide to withdraw your application, you must make the request in writing. The request must be received prior to the Board considering licensure.

Criminal History

Any applicant who has ever been found guilty of, or pled guilty or no contest to/nolo contendere, any charge other than a minor traffic offense must list each offense on the application. Failure to disclose criminal history may result in denial of your application. Each application is reviewed on its own merits. Staff cannot make predeterminations in advance as laws and rules do change over time.

Violent crimes and repeat offenders are required to be presented to the Board of Nursing for review.

Applicants with criminal convictions may be required to submit the following documents:

Final Dispositions/Sanctions –Final disposition records for offenses can be obtained at the

clerk of the court in the arresting jurisdiction. If the records are not available, you must have a letter on court letterhead sent from the Clerk of the Court attesting to their unavailability.

Completion of Probation/Parole –Probation records for offenses can be obtained at the clerk of the court in the arresting jurisdiction. If the records are not available, you must have a letter on court letterhead sent from the Clerk of the Court attesting to their unavailability.

Self-Explanation –Applicants who have listed offenses on the application must submit a letter in your own words describing the circumstances of the offense.

Letters of Recommendation –Applicants who have listed offenses on the application must submit 3-5 letters of recommendation from people you have worked for or with.

Disciplinary History

Any applicant who has ever been denied, had disciplinary action, or surrendered a license to practice in any healthcare profession, in any state, jurisdiction, or country must provide a self-explanation of all occurrences of denial, disciplinary action or surrendering of a license. The State Board(s) of Nursing involved must also submit copies of the administrative complaint and final order directly to the Florida Board. Applicants are responsible to ensure that the proper documentation is sent to the Florida Board. Any action taken against your license by a state licensing board must be reported on this application.

Healthcare Fraud

IMPORTANT NOTICE: Applicants for licensure, certification or registration and candidates for examination may be excluded from licensure; certification or registration if their felony conviction falls into certain timeframes as established in Section 456.0635(2), Florida Statutes. For more information,

please visit our website at: http://floridasnursing.gov/licensing/certified-nursing-assistant-endorsement/.

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Florida Board of Nursing

PO Box 6330

Tallahassee, FL 32314

Phone: (850) 245-4125

Fax: (850) 617-6460

Certified Nursing Assistant Licensure by Endorsement Application

Website: www.floridasnursing.gov

Email: mqa.cna@flhealth.gov

Please complete this application in its

entirety prior to printing.

1.PERSONAL INFORMATION

Name:

 

 

 

 

 

Date of Birth:

 

 

Last/Surname

First

 

Middle

 

MM/DD/YYYY

Mailing Address: (Give the address where mail and your license should be sent)

 

 

 

 

 

 

 

 

 

 

 

 

 

Street/P.O. Box

 

 

 

 

 

Apt. No.

 

 

City

 

 

 

 

 

 

 

 

 

 

 

 

 

State

 

Zip

Country

Home/Cell Telephone (Input with dashes)

 

Physical Location: (Required if mailing address is a P.O. Box- This address will be posted on the Department of Health's website.)

Street

 

 

 

Apt./Suite No.

City

 

 

 

 

 

 

 

 

State

 

Zip

Country

Work/Cell Telephone (Input with dashes)

EQUAL OPPORTUNITY DATA:

We are required to ask that you furnish the following information as part of your voluntary compliance with Section 2, Uniform Guidelines on Employee Selection Procedure (1978) 43 CFR 38295 and 38296 (August 25, 1978). This information is gathered for statistical and reporting purposes only and does not in any way affect your candidacy for licensure.

SEX:

Male

Female

RACE:

White

 

 

 

 

Black or African American

 

 

 

 

Hispanic

 

 

 

 

American Indian or Alaska Native

 

 

 

 

Asian

 

 

 

 

Native Hawaiian or Other Pacific Islander

 

 

 

 

Two or More Races

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Page 1

NAME

Email Notification: If you want to be notified of the status of your application by email please check the "Yes" box and write your email address on the line provided below. If you choose this form of notification you will receive information

regarding your application file through email. You will be responsible for checking your email regularly and updating your email address with the Board office at: mqa.cna@flhealth.gov

I want to be notified by email

Yes

No

 

 

Email Address:

 

 

 

Under Florida law, email addresses are public records. If you do not want your e-mail address released in response to a public records request, do not provide an email address or send electronic mail to our office. Instead contact the office by phone or in writing.

2.APPLICANT BACKGROUND Attach additional sheets, if necessary

A.List any other name(s) by which you have been known in the past.

B.What name(s) did you use when you received your education?

C.What name did you use when you were first licensed?

D.Have you ever applied for licensure by examination in Florida, as a CNA? Date

Yes No

E.Have you ever applied for licensure by endorsement in Florida, as a CNA? Date

Yes No

F.Have you ever been licensed in Florida as a CNA? Date

Yes No

G.* Have you ever been denied or is there now any proceeding to deny your application for any health care license to practice in Florida or any other state, jurisdiction or country?

Yes No

*If you answer “Yes” to question G in this section, you must submit a self explanation as to why you are answering “Yes” to this question.

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NAME

H. List all CNA licenses ( active, inactive or lapsed)

 

State/Country

 

 

License No.

 

License Type Date of Licensure

 

Status of License and Expiry Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Florida Board of Nursing requires verification of licensure from from a state where you have a current active license.

3.

A.

B.

C.

CRIMINAL HISTORY

Answers to commonly asked questions can be found on our website at:

 

 

 

http://www.floridasnursing.gov/help-center/#faqs

Yes

No

Have you EVER been convicted of, or entered a plea of guilty, nolo contendere, or no

 

 

contest to, a crime in any jurisdiction other than a minor traffic offense? You must

 

 

include all misdemeanors and felonies, even if adjudication was withheld.

 

 

Reckless driving, driving while license suspended or revoked (DWLSR), driving

 

 

under the influence (DUI) or driving while impaired (DWI) are not minor traffic offenses

 

 

for purposes of this question.

Yes

No Have you EVER had any records sealed pursuant to section 943.059, F.S., or other states

 

 

applicable statute?

Yes

No

Have you EVER been adjudicated delinquent?

Failure to disclose information in this section may result in a denial of your application.

If you answered “Yes” to any of the questions above you are required to send the following items:

Self Explanation describing in detail the circumstances surrounding each offense; including dates, city and state, charges and final results.

Final Dispositions and Arrest Records for all offenses. The Clerk of the Court in the arresting jurisdiction will provide you with these documents. Unavailability of these documents must come in the form of a letter from the Clerk of the Court.

Completion of Sentence Documents. You may obtain documents from the Department

of Corrections. The report must include the start date, end date, and state that the conditions have been met.

Three (3) current (written within the last year) Letters of Recommendation.

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NAME

4.

Electronic Fingerprinting:

(Required for ALL applicants)

 

 

 

 

All applicants, including out-of-state and out-of-country applicants, are required to submit their fingerprints electronically. The Department of Health accepts electronic fingerprinting offered by Livescan device providers that are approved by the Florida Department of Law Enforcement. For a list of approved Livescan vendors, please visit our website at : http://www.flhealthsource.gov/background-screening/

Typically background results submitted by Livescan are received by the Board within 24-72 hours of being processed. The Board of Nursing's ORI number is: ED0380Z. The Board cannot accept hard fingerprint cards or results. All results must be submitted electronically by the Livescan service provider.

Livescan screenings done by a Florida Police or Sheriff's Department require that you login to the FDLE Civil Applicant Payment System (CAPS) at https://caps.fdle.state.fl.us and pay a fee before results will be released to our office.

Applicants who reside in an area where no Livescan service providers are available or because of state laws prohibiting transmission of fingerprints electronically across state lines should contact a Florida Livescan service provider who has the capability to convert a traditional card (hard card) into an electronic fingerprint card.

Because the Florida Department of Health retains fingerprints on any applicant who is required to undergo a criminal history screening as of January 1, 2013, those prints are retained in the Care Provider Clearinghouse. This Clearinghouse allows for the sharing of criminal history information among specified agencies.

One of the requirements for your Livescan to be retained in the Clearinghouse is a photograph taken by the Livescan service provider at time of fingerprinting. If your Livescan is completed without a photograph, you may have to undergo additional fingerprinting in the future.

Applicants needing hard fingerprint cards can request them via email at: Mqa.BackgroundScreen@flhealth.gov

Please include your current mailing address in your request for fingerprint cards.

The Board cannot accept hard fingerprint cards or results.

For Frequently Asked Questions about Livescan and for a list of providers who offer hard card conversion see our website at:

http://www.flhealthsource.gov/background-screening/

LIVESCAN PRIVACY STATEMENT

I have been provided and read the statement from the Florida Department of Law Enforcement regarding the sharing, retention, privacy and right to challenge incorrect criminal history records and the “Privacy Statement” document from the Federal Bureau of Investigation. (Found in the forms following this application). The Board will not receive your Livescan results if you do not affirm the above statement by checking this box.

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NAME

5.

A.

B.

C.

DISCIPLINARY HISTORY

Yes

No

Have you ever had disciplinary action taken against your license to practice any

 

 

health care related profession by the licensing authority in Florida or in any other state,

 

 

jurisdiction or country?

Yes No Have you ever surrendered a license to practice any health care related profession in Florida or in any other state, jurisdiction or country while any such disciplinary charges were pending against you?

Yes No Do you have disciplinary action pending against any license?

Failure to disclose information in this section may result in a denial of your application.

If you answered “Yes” to any of the questions in this section, you are required to send the following items:

Self Explanation, describing in detail the circumstances surrounding the disciplinary action.

A copy of the Administrative Complaint and Final Order.

Three (3) current (written within the last year) Letters of Recommendation.

6. CRIMINAL AND MEDICAID/MEDICARE FRAUD QUESTIONS

IMPORTANT NOTICE: Applicants for licensure, certification or registration and candidates for examination may be excluded from licensure, certification or registration if their felony conviction falls into certain timeframes as established in Section 456.0635(2), Florida Statutes. If you answer “Yes” to any of the following questions, please provide a written explanation for each question including the county and state of each termination or conviction, date of each termination or conviction, and copies of supporting documentation to the address below. Supporting documentation includes court dispositions or agency orders where applicable.

1. Yes No Have you been convicted of, or entered a plea of guilty or nolo contendere, regardless of adjudication, to a felony under Chapter 409, F.S. (relating to social and economic assistance), Chapter 817, F.S. (relating to fraudulent practices), Chapter 893, F.S. (relating to drug abuse prevention and control) or a similar felony offense(s) in another state or jurisdiction?

If you responded “No”to the question above, skip to question 2.

a

.

Yes

No If “Yes” to 1, were you arrested or charged for the felony or felonies after July 1, 2009?

b.

Yes

No If “Yes” to 1, for the felonies of the first or second degree, has it been more than 15

 

 

 

years from the date of the plea, sentence and completion of any subsequent probation?

c. Yes No If “Yes” to 1, for the felonies of the third degree, has it been more than 10 years from the date of the plea, sentence and completion of any subsequent probation? (This question does not apply to felonies of the third degree under Section 893.13(6)(a), Florida Statutes).

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Page 5

NAME ______________________________________________

d. Yes No If “Yes” to 1, for the felonies of the third degree under Section 893.13(6)(a), Florida Statutes, has it been more than 5 years from the date of the plea, sentence and completion of any subsequent probation?

2.

e. Yes No

Yes No

If “Yes” to 1, have you successfully completed a drug court program that resulted in the plea for the felony offense being withdrawn or the charges dismissed? (If “Yes”, please provide supporting documentation).

Have you been convicted of, or entered a plea of guilty or nolo contendere to, regardless of adjudication, to a felony under 21 U.S.C. ss. 801-970 (relating to controlled substances) or 42 U.S.C. ss. 1395-1396 (relating to public health, welfare,

Medicare and Medicaid issues)?

3.

4.

5.

If you responded “No” to the question above, skip to question 3.

a.

Yes

No If “Yes” to 2, were you arrested or charged for the felony or felonies after July 1, 2009?

b. Yes No If “Yes” to 2, has it been more than 15 years before the date of application since the sentence and any subsequent period of probation for such conviction or plea ended?

Yes No Have you ever been terminated for cause from the Florida Medicaid Program pursuant to Section 409.913, Florida Statutes?

If you responded “No” to the question above, skip to question 4.

 

Yes

No If you have been terminated but reinstated, have you been in good standing with the

 

 

Florida Medicaid Program for the most recent five years?

Yes

No

Have you ever been terminated for cause, pursuant to the appeals procedures

 

 

established by the state, from any other state Medicaid program?

If you responded “No” to the question above, skip to question 5.

a. Yes No Have you been in good standing with a state Medicaid program for the most recent five years?

b. Yes No Did the termination occur at least 20 years before to the date of this application?

Yes No Are you currently listed on the United States Department of Health and Human Services' Office of Inspector General's List of Excluded Individuals and Entities?

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Page6

7.

Confidential and Exempt from Public Records Disclosure

Pursuant to Sec. 466 [42 U.S.C. 666](a), the department is required and authorized to collect Social Security Numbers relating to applications for professional licensure. Additionally, section 456.013(1)(a), Florida Statutes, authorizes the collection of Social Security Numbers as part of the general licensing provisions. This information is exempt from public records disclosure.

Last Name:

First Name:

Middle Name:

Social Security Number:

(Input with dashes)

Social Security Information - * Under the Federal Privacy Act, disclosure of Social Security numbers is voluntary unless specifically required by federal statute. In this instance, Social Security numbers are mandatory pursuant to Title 42 United States Code, Sections 653 and 654; and Section 456.013(1), 409.2577 and 409.2598, Florida Statutes. Social Security numbers are used to allow efficient screening of applicants and licensees by a Title IV-D child support agency to ensure compliance with child support obligations. Social Security numbers must also be recorded on all professional and occupational license applications and will be used for license identification pursuant to the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (Welfare Reform Act. 104 Pub.L. Section 317) Clarification of the SSA process may be reviewed at www.ssa.gov or by calling 1-800-772-1213.

Board of Nursing

4052 Bald Cypress Way, Bin # C02

Tallahassee, Florida 32399-3252

Phone: (850) 245-4125 Fax: (850) 617-6460

Website: www.floridasnursing.gov

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NAME

8. HEALTH HISTORY (Supporting documentation should be sent directly to the board office.)

A. Yes No

B. Yes No

Do you have any condition that currently impairs your ability to practice your profession with reasonable skill and safety?

Are you using medications, other drugs, narcotics, or intoxicating chemicals that impair your ability to practice your profession with reasonable skill and safety?

.

If you answered “Yes” to any of the questions in this section, you are required to send the following items:

Please provide a letter from a licensed health practitioner, who is qualified by skill and training to address your condition, which explains the impact your condition may have on your ability to practice your profession with reasonable skill and safety, and stating either that you are safe to practice your profession without restriction or indicating what restrictions are necessary. If necessary, you may

attach additional sheets.

Documentation must be current within the last year.

If you fail to disclose the information requested in this section, your application may be denied.

Self Explanation, explaining the medical condition(s) or occurrence(s) and current status.

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Page8

Get PDF Form

Document Overview

Fact Name Description
Application Integrity Providing false information on your application may lead to denial by the Board of Nursing.
Out-of-State Certification Your out-of-state certificate must be clear/active and in good standing for your application to be considered. Document Submission All documents submitted become a permanent part of your file and cannot be returned.
Livescan Fingerprinting Fingerprinting must be electronically submitted through an approved Livescan provider.
Application Updates Any changes affecting your application responses must be reported to the Board office in writing.
Withdrawal of Application If you decide to withdraw your application, it must be done in writing before the Board considers licensure.
Criminal History Disclosure Failure to disclose criminal history may lead to application denial, with each application reviewed individually.
Disciplinary History Any prior denials, disciplinary actions, or surrendered licenses in any healthcare field must be disclosed, including supporting documentation.
Healthcare Fraud Impact Felony convictions may exclude applicants from licensure, in accordance with Section 456.0635(2), Florida Statutes.

Instructions on How to Fill Out Cna License To Florida

When applying to transfer a Certified Nursing Assistant (CNA) license to Florida, it's important to follow the provided checklist meticulously to ensure your application is processed efficiently. A well-completed application includes accurate information and all necessary documents. Any omission or provision of false information can result in delay or denial of licensure. After submission, your application will undergo review by the Board of Nursing, and you will be notified of your application status. Additionally, keep the Board updated on any changes to your application details to avoid further delays. The following steps will guide you through completing the CNA License to Florida form.

  1. Gather all necessary documents, including proof of active certification from your current state, a completed Confidential and Exempt from Public Records Disclosure Form, and a Livescan service for electronic fingerprint submission.
  2. Complete the Personal Information section with your name, date of birth, and contact information. Specify your sex and race for statistical purposes. If you prefer email notifications about your application, check "Yes" and provide your email address.
  3. In the Applicant Background section, list any other names you have used, your educational background, and details about any previous applications or licenses in Florida or other states. For any question answered with "Yes," be prepared to provide a detailed explanation or additional documentation as required.
  4. List all states/countries where you hold or have held a CNA license, including license numbers, the type of license, issuance dates, and expiry dates. Verification of licensure may be requested from the state of your active license.
  5. Address your Criminal History. Be honest about any convictions or pleas, excluding minor traffic offenses. Answering "Yes" requires a submission of detailed descriptions of the circumstances, final dispositions, arrest records, sentence completion documents, and letters of recommendation.
  6. Collect and prepare any additional documentation regarding disciplinary actions or license denials from other healthcare boards if applicable. Include self-explanations and the required formal documentation from the state boards of nursing involved.
  7. Make sure your application is signed. An unsigned application will delay the processing.
  8. Review your application and checklist to ensure all parts are completed and no required documents are missing. Remember, incomplete applications can delay processing.
  9. Mail the application along with the additional documents to the Department of Health Certified Nursing Assistant Registry at the provided address.

The overall success of your application depends on careful preparation and comprehensive completion of all required fields and documents. Once submitted, your application will join a queue for review based on the date of reception. By adhering to these steps, you increase the likelihood of a smoother approval process for transferring your CNA license to Florida.

Listed Questions and Answers

What documents do I need to submit with my Certified Nursing Assistant (CNA) License by Endorsement Application to Florida?

To ensure your CNA License by Endorsement Application is complete and processed without delay, you should include: a fully completed application with your signature, proof of your active certification that is clear/active and in good standing from another state, a completed Confidential and Exempt from Public Records Disclosure Form, and fingerprints submitted electronically through a Livescan provider approved by the Florida Department of Law Enforcement. Remember, any missing items can delay the approval of your application, and all submitted documents become a permanent part of your file and cannot be returned.

How do I submit my fingerprints for the CNA License to Florida application, and which Livescan providers are approved?

Fingerprints for the CNA License to Florida must be submitted electronically through a Livespan provider that is approved by the Florida Department of Law Enforcement. You can find a list of approved Livescan vendors by visiting the Florida Health Source website. Make sure to use the correct ORI number, EDOH4400Z, when submitting your fingerprints to ensure they are routed correctly to the Department of Health. This step is vital for the background screening process, which is mandatory for all applicants.

What should I do if I have a criminal history?

If you have ever been found guilty of, or pled guilty or no contest to, any charge other than a minor traffic offense, it's crucial to list each offense on your application. Depending on the nature and details of the criminal history, you may need to provide additional documents including final dispositions/sanctions, completion of probation/parole records, a self-explanation letter describing the circumstances of the offense in detail, and 3-5 letters of recommendation from people you have worked for or with. Failure to disclose criminal history may result in the denial of your application. Each case is reviewed independently, and full disclosure is necessary to determine eligibility for licensure.

Can my application be denied, and how do I update my application if something changes?

Yes, your application can be denied if you provide false information, fail to disclose required information such as criminal history, or if there are issues with your professional disciplinary history. It's important to answer all questions on the application truthfully and completely. If anything changes that affects a response on your application, or if you need to update your personal details (such as a change of name, address, or contact information), you must notify the Board office in writing. Keeping your application up to date is crucial to avoid processing delays or denial of your application. If you decide to withdraw your application, you must also make this request in writing.

Common mistakes

Filling out the CNA License to Florida form requires attention to detail and completeness to avoid delays or denial of your application. Here are seven common mistakes people make during this process.

  1. Not completing every section of the application: Every question must be answered thoroughly. Leaving sections incomplete can lead to significant delays in the approval of your application.
  2. Providing false information: Honesty is crucial when filling out the application. The Board of Nursing may deny your application if it is discovered that false information was submitted.
  3. Failing to provide proof of active certification: Applicants must show that their out-of-state certificate is clear, active, and in good standing. Neglecting to include this proof can be a critical oversight.
  4. Omitting the Livescan fingerprints submission: All applications must include electronically submitted fingerprints through an approved Livescan provider. Failure to comply with this requirement will halt the application process.
  5. Not notifying the Board of any changes: Any changes that affect responses provided in the application must be communicated to the Board office in writing. Changes can include personal information or any disciplinary actions or criminal convictions that occur after the application submission.
  6. Failure to disclose criminal history: Applicants must list all offenses, other than minor traffic infractions. Not disclosing your criminal history can result in the denial of your application.
  7. Inadequate documentation for disciplinary or criminal history: Applicants with a disciplinary or criminal history need to provide comprehensive documentation, including self-explanations, final dispositions, and letters of recommendation. Insufficient documentation can lead to application delays or denial.

Avoiding these common pitfalls will help ensure a smoother application process when applying for a CNA License in Florida. For additional guidance, applicants should carefully review all instructions and requirements listed on the Florida Board of Nursing website.

Documents used along the form

When applying for a Certified Nursing Assistant (CNA) License to Florida, several other forms and documents are often required alongside the main application. This ensures a thorough and complete application process, thus facilitating smoother processing by the Board of Nursing. Here is a brief overview of these essential documents.

  • Proof of Education: Documentation certifying the completion of a state-approved nursing assistant training program. This usually includes a diploma, certificate, or transcript.
  • Verification of Out-of-State License: A form or letter from the state where the applicant is currently certified, verifying the status and standing of their CNA license.
  • Criminal Background Check: Results of a background check, often obtained through Livescan fingerprinting, which is a requirement for the Florida Board of Nursing.
  • Self-Explanation Letter: If applicable, a letter written by the applicant explaining any criminal convictions, disciplinary actions, or other matters that require disclosure.
  • Letters of Recommendation: Typically required from applicants with a history of criminal convictions or disciplinary actions. These letters should come from professional or academic sources attesting to the applicant’s character and qualifications.
  • Healthcare Fraud Screening Document: A form or document certifying that the applicant does not have a felony conviction related to healthcare fraud, in line with Florida statutes.
  • Change of Name Documentation: If applicable, official documents such as a marriage certificate or court order proving a legal change of name. This is important for ensuring the applicant’s record is accurate and up to date.

Collecting and preparing these documents may take time but is a crucial step in transitioning a CNA license to Florida. Properly completed and submitted, these supplementary forms facilitate a smoother verification and licensing process, aiding applicants in meeting the Florida Board of Nursing’s requirements. It’s always recommended to review current guidelines and consult with the Board if there are any uncertainties regarding the necessary documentation.

Similar forms

The CNA License to Florida form is similar to other licensure application forms used by healthcare professionals across various states, including Registered Nurses (RN) and Licensed Practical Nurses (LPN) applications. These documents often require detailed personal information, educational background, proof of previous licensure, and a clear criminal background check. Specifically, like the CNA application, RN and LPN forms necessitate verification of out-of-state licenses, a comprehensive record of any criminal history, and confirmation of educational qualifications. The intention behind these requirements is to ensure that all healthcare providers meet the stringent standards set forth by the state for the safety of the public. Additionally, they must include a Livescan fingerprint submission for a background check, echoing the procedure mandated by the Florida CNA license application. This rigorous process is designed to vet applicants thoroughly and maintain a high standard of healthcare service.

Another document that shares similarities with the CNA License to Florida form is the application for Medical Doctor (MD) licensure. Both applications demand an exhaustive list of personal details, including previous names used, a history of education, and a list of states where the applicant has been previously licensed. Crucially, they both emphasize the importance of disclosing any criminal history, with detailed instructions on how to report and substantiate such disclosures with official records or letters of explanation. Bearing similar weight on transparency, both forms require the applicant to notify the board of any changes in the application information or any new occurrences that might affect licensure eligibility, such as criminal charges or disciplinary actions in other states. This parallel underscores the accountability and integrity expected of healthcare professionals in Florida, aiming to protect patient well-being and uphold the prestige of the medical community.

Dos and Don'ts

When applying for the Certified Nursing Assistant (CNA) License in Florida, it is crucial to follow specific guidelines to ensure that your application is complete and submitted correctly. Here is a list of dos and don'ts to help guide you through the process:

  • Do complete the entire application before printing it. Every question should have an answer.
  • Do sign your application. An unsigned application is incomplete.
  • Do provide proof that your out-of-state certificate is Clear/Active and in good standing.
  • Do include the completed "Confidential and Exempt from Public Records Disclosure" form.
  • Do submit fingerprints electronically through a Livescan provider approved by the Florida Department of Law Enforcement.
  • Do notify the Board office in writing of any changes that affect your application, such as a change of name or address.
  • Do disclose any criminal history. Failure to do so may result in the denial of your application.
  • Don't provide false information on your application. This may lead to denial of your application.
  • Don't leave any question unanswered. Incomplete applications will delay the approval process.
  • Don't forget to mail applications and additional documents to the Department of Health Certified Nursing Assistant Registry at the specified address.

Following these guidelines carefully will help streamline the application process and increase the likelihood of approval for the Certified Nursing Assistant License in Florida.

Misconceptions

Transferring a Certified Nursing Assistant (CNA) license to Florida involves navigating through the application process, and applicants often come across numerous misconceptions. It's crucial to address these misunderstandings for a smoother application experience.

  • Completing the application partially is okay as long as important sections are filled out.
    Every part of the application is important. Failing to complete any section can delay the approval process.
  • Documents submitted with the application can be returned upon request.
    All submitted documents become a permanent part of your file with the Florida Board of Nursing and cannot be returned.
  • It doesn’t matter when you submit your application.
    Applications are reviewed in the order they are received. Delay in submission can thereby affect the final approval timing.
  • Honesty in the application is optional.
    Honesty is not just recommended; it's required. Providing false information can lead to the denial of your application.
  • Proof of active certification isn’t strictly necessary.
    Your out-of-state certificate must be clear, active, and in good standing to be considered for endorsement in Florida.
  • All applicants must mail their fingerprints separately.
    Fingerprints must be submitted electronically through a Livescan provider approved by the Florida Department of Law Enforcement. This process is integrated with the application procedure, not separate.
  • A criminal history will automatically disqualize you.
    While a criminal history must be disclosed, each application is reviewed individually. The nature of the conviction and evidence of rehabilitation are considered. Failing to disclose such information, however, may lead to denial of your application.

Understanding these aspects of the application process can help ensure that your journey to becoming a CNA in Florida is as smooth as possible. Always refer to the latest guidelines provided by the Florida Board of Nursing to stay up to date.

Key takeaways

When applying for a Certified Nursing Assistant (CNA) license in Florida, it's paramount to follow guidelines meticulously to ensure the process proceeds smoothly. Below are four key takeaways to help applicants navigate the process:

  • Complete the application thoroughly: Every question on the Certified Nursing Assistant Licensure by Endorsement Application must be answered fully and honestly. Incomplete applications, or those containing false information, can lead to delays or denial of licensure by the Florida Board of Nursing. It's also necessary to update the Board office with any changes that might affect your application, such as changes in name, address, or criminal history.
  • Ensure your certification is valid and in good standing: Applicants must provide proof that their out-of-state certification is clear/active and that they are in good standing. This involves verifying licensure from a state where the applicant has a current active license, as required by the Florida Board of Nursing.
  • Submit to a background check: A crucial step in the application process is submitting fingerprints electronically through a Florida Department of Law Enforcement (FDLE)-approved Livescan provider. This step is mandatory for all applicants, as it allows the Department of Health to conduct a thorough background screening.
  • Disclose any criminal or disciplinary history: Applicants must list any criminal charges (beyond minor traffic offenses) and any past disciplinary actions or denials of licensure in the healthcare field. Failure to disclose such information can lead to application denial. Those with criminal convictions or disciplinary actions must provide detailed explanations and supporting documentation, including final dispositions, probation records, and letters of recommendation.
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