1. (a) An applicant for certification as a nurse aide shall submit

   1. (1) a completed application, on a form provided by the department, that verifies that the applicant meets the requirements of 12 AAC 44.800(a) or 12 AAC 44.805; the application must include

      1. (A) the applicant's signature that certifies that the information in the application is correct to the best of the applicant's knowledge;
      2. (B) the applicant's personal identification information requested on the form;
      3. (C) an attestation that the applicant has completed or is eligible to complete a state approved nurse aide training program;
      4. (D) information related to the grounds for license denial, suspension, or revocation set out in AS 08.68.270;
   2. (2) the applicable fees established in 12 AAC 02.282;
   3. (3) the applicant's fingerprint information required by 12 AAC 44.812;
   4. (4) an additional application fee and fingerprint processing fee, if the submitted application has remained dormant for over one year from the original date of application;
   5. (5) the nurse aide program verification form, completed by an official of the program attended; the form must be submitted directly to the department from the nurse aide training program; and
   6. (6) at the written request of the board, additional information that is necessary to demonstrate that the applicant has met the licensing requirements of AS 08.68 and this chapter.
2. (b) An application for certification under 12 AAC 44.800 is also the application to take the competency evaluation required under 12 AAC 44.800(b).

3. (c) If an applicant applies for certification by endorsement under 12 AAC 44.805, the applicant shall provide certificate verification on a form provided by the department. The certificate verification must be completed by an official of the certifying jurisdiction in which the applicant was certified by examination and from the jurisdiction in which the applicant is currently certified. The jurisdiction that certified the applicant by examination must verify that the applicant obtained certification by successfully completing

   1. (1) a state-approved nurse aide training program that meets the requirements set out under 42 C.F.R. 483.152; and
   2. (2) a nurse aide competency evaluation that meets the requirements set out under 42 C.F.R. 483.154.

(Eff. 2/14/99, Register 149; am 6/16/2002, Register 162; am 10/9/2002, Register 164; am 8/10/2016, Register 219; am 5/16/2018, Register 226; am 5/8/2025, Register 254)

Authority: AS 08.68.100, AS 08.68.331