Download New York Nurse 1 Template in PDF

The New York Nurse 1 form serves as a crucial document for individuals seeking licensure as nurses in New York. Several other forms share similarities with this application. Below is a list of four such documents, along with a description of how each is related to the New York Nurse 1 form.

• New York Nurse Form 3: This form is utilized for license verification. Applicants must submit it if they hold or have held a nursing license in another state. Like the Nurse 1 form, it requires detailed information about the applicant’s professional history and credentials.
• Application for Licensure as a Practical Nurse: Similar to the Nurse 1 form, this application is specifically for individuals applying to become Licensed Practical Nurses (LPNs). It also includes sections on personal information, educational background, and criminal history, mirroring the structure of the Nurse 1 form.
• Child Abuse Identification and Reporting Coursework Certification: This document is required for Registered Nurse applicants to certify completion of child abuse training. Both forms emphasize the importance of specific training requirements and necessitate proof of completion to proceed with licensure.
• Affidavit for Professional Licensure: This affidavit is required for various professional licenses in New York. Like the Nurse 1 form, it includes a section for notarization, affirming the truthfulness of the information provided by the applicant.

Guide to Filling Out New York Nurse 1

Completing the New York Nurse 1 form is a crucial step in the licensure process for nursing professionals. After filling out the form, it must be submitted along with the required fee to the appropriate office. This guide provides clear steps to help ensure that the application is completed accurately and efficiently.

1. Obtain the New York Nurse 1 form from the New York State Education Department website.
2. Fill out your Social Security Number and Birth Date. Leave the birth date blank if you do not have a U.S. Social Security Number.
3. Print your Name clearly in the designated fields: Last, First, and Middle.
4. Provide your Telephone/Email Address. Indicate whether it is a home or business number.
5. Complete your Mailing Address with all required lines and ensure it is clearly printed.
6. If applicable, enter your New York State DMV ID Number. Leave it blank if you do not have one.
7. Indicate if you have a CGFNS record and provide the number if you answered "yes."
8. Fill in your Name as it appears on degree or other credentials if it differs from your application name.
9. Answer the questions regarding previous applications for licensure, criminal history, and any disciplinary actions.
10. If you answer "yes" to questions numbered 10-14, prepare a detailed letter explaining the circumstances.
11. List any professional licenses or certificates you hold or have held in other states or jurisdictions.
12. Provide details about all schools, colleges, or universities you attended. Ensure to include all required information.
13. Complete the section regarding any licensure examinations you have taken, including the state and exam name.
14. Certify your Child Support Obligation by checking the appropriate box.
15. Indicate your Citizenship/Immigration Status by checking the applicable box and providing your USCIS number if necessary.
16. Check the boxes for Child Abuse Identification and Reporting Coursework Requirement and Infection Control Training Requirement as applicable.
17. Indicate if you require reasonable testing accommodations for a disability.
18. Optionally, provide information regarding your Gender and Ethnicity for statistical purposes.
19. Give permission for the New York State Education Department to release your examination results for program review.
20. Sign and date the Affidavit in the presence of a Notary Public.
21. Mail the completed form along with the $143 fee to the specified address for initial applications or the updated address if requested by the Department.