Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
If you download an application from the Boards website, a fingerprint card will be mailed to you upon receipt of your application in the Board office. If you request an application by mail, a fingerprint card will be included in that packet. You may choose to submit the fingerprint card at the same time as your application but it isnt necessary to do so. 1. All applicants must complete a fingerprint card (Form FD-258) provided by the Nevada State Board of Nursing (the Board); OR If you fingerprint in Nevada, you may choose to have your fingerprints submitted via electronic transmission (livescan) instead of submitting a card. Electronic transmission is only available if you have your fingerprints captured in Nevada. 2. Complete the information block on the card, and make sure it is legible: last, first, and middle names; signature; residence (complete address); citizenship; date of birth; place of birth; sex; race; height; weight; eyes; hair; and Social Security number (if you have one). Cards without these information blocks completed are considered incomplete and will be returned to the applicant. Illegible cards cannot be processed. 3. Fingerprinting on the Boards coded card may be done by a law enforcement agency in any state or by a private fingerprinting service. (The Boards website www.nevadanursingboard.org has a list of Nevada fingerprinting locations that offer electronic submission as well as fingerprinting on cards.) The Board provides fingerprint capture by appointment in its offices. 4. Complete and detach the form on the reverse side, and send the fee and completed fingerprint card to the address below. If you have your fingerprints submitted by electronic submission, you will make payment to the agency that captures your fingerprints, but you must send a copy of your receipt to the Board. 5. Be sure: You have your fingerprints captured at an in-state (NV) livescan location (recommended); OR A fingerprint card is completed and the card is not folded, torn or damaged in any way. The Information block is complete and legible The card is signed by the appropriate persons (applicant and official) The coded card (Form FD-258) provided by the Board is used exclusively
NURSING
Nevada State Board of
12-10-12
Please note: If you have previously been fingerprinted for your place of employment or another board of nursing, we are unable to use those results. Federal law prohibits the sharing of fingerprint information. You will need to be fingerprinted specifically for the Nevada State Board of Nursing.
WARNING: Due to various factors, it may take up to four months for the Board to receive the official fingerprint results from the Department of Public Safety and FBI. A permanent license/certificate will not be issued prior to receipt of both fingerprint reports. A temporary license cannot be extended beyond the 6-month expiration date. You are urged to fingerprint early in the application process.
EMS/RN
Renewal
If paying by credit or debit card, please complete: Visa____ MasterCard___ Discover___ AMEX___ Card number___________________________ Exp. date_____ Name on card________________________________ Amount $51.25 Signature_____________________________
NURSING
Nevada State Board of
4. Completed fingerprint cards (see separate instructions and submission form for information on how to obtain and submit the fingerprint cards). Note: a permanent license will not be issued until the Board receives fingerprint reports from the Nevada Department of Public Safety and the Federal Bureau of Investigation, and any issues have been resolved. IMPORTANT!! Please do not send any documents before you submit your application. The Board will not accept any required documents unless they are submitted with (or after) your application.
Examination Information
Steps:
Submit items 1-4 (under Application Instructions above) to the Board. Submit NCLEX application and fee separately to the NCLEX Testing Service, Pearson Vue. The application is only available online at http://www.pearsonvue.com/NCLEX. Each examination attempt will require a new Pearson Vue application and fee. Once youve submitted items 1-3 (above) and the NCLEX application and fee, the Board will make you eligible to test and you will receive an Authorization to Test (ATT) from Pearson Vue. (continued)
After you receive your ATT, contact Pearson Vue to schedule a test date. You must test within 90 days of receiving your ATT.
Examination Results Although it is possible for applicants to obtain unofficial results, the Board cannot issue a permanent license until your official results are received. Once received by the board, your written results will be sent to your address of record. The Board will not give you the results over the telephone. Interim Permit The Board may grant an Interim Permit to a first-time examinee after the Board receives the application and documentation of graduation from an approved nursing education program. The Interim Permit allows the examinee to practice as a Graduate Nurse only in the state of Nevada and only for 90 days. The Interim Permit expires upon notification of examination failure, regardless of the time remaining on the Interim Permit. Authority to practice as a Graduate Nurse then ceases. Interim Permits will not be extended beyond the original 90 days of issue.
Broker/Third Party
If you wish to have a third party act upon your behalf for licensure purposes, please sign the authorization form, have it notarized, and return it to the Board.
General Information
Follow all instructions. All questions in all sections must be answered completely and the answers legibly written. Incomplete applications will not be processed. Your application for licensure is valid for one year from the date received by the Board. It is your responsibility to follow up with the Board to determine the ongoing status of your application. The address furnished on this application will become your address of record unless you indicate otherwise. You must notify the Board, in writing, within 30 days of any change in your address of record. You may check to see if your license has been issued by visiting the license/certificate verification section of our website www.nevadanursingboard.org. Nevada does not issue hard card licenses. No license card will be mailed to you.
Time frame: As processing of your application is dependent on receiving documents from outside
sources, we are unable to provide specific time frames for processing. However, if your application is complete and meets the criteria for issuance of a license/certificate, we can generally issue your (temporary or permanent) license/certificate within one week of receipt of your application and applicable documents.
5011 Meadowood Mall Way, Suite 300, Reno, NV 89502-6576 (fax) 775-687-7707 2500 W. Sahara Avenue, Suite 207, Las Vegas, NV 89102-4392 (fax) 702-486-5803 www.nevadanursingboard.org 888-590-6726 nursingboard@nsbn.state.nv.us rev. 04-04-12
2.
OR 3. Pearson Test of English Academic with a minimum passing score of 55 and no individual section below 50 For Pearson Test of English information Contact Website www.pearsonpte.com/testme/pages/testcenters.aspx
All English language proficiency test results must be sent to the Nevada State Board of Nursing, 2500 W. Sahara Avenue, Suite 207, Las Vegas, NV 89102-4392.
3.
***Validation of licensure in the country where you completed your nursing education program.
All graduates of international nursing schools must submit validation that nursing licensure (currently active or expired) was issued by the legally authorized authority in the country where their nursing program was completed. This information may be available on your CGFNS report; however, if this licensure information is not available on your CGFNS report, you must provide documentation directly to the Board from the legally authorized authority in the country where your nursing education was completed that you were issued a valid license to practice nursing in that country.
4.
For your quick reference, below is a list of the steps international graduates need to take. Please do not use this as a substitute for carefully reading and following the application instructions.
1) Apply for the CGFNS-CES*. 2) Apply for validation of English language proficiency** 3) Provide verification of licensure in the country where you completed your nursing education program*** 4) Complete and submit the application for RN/LPN licensure. 5) Complete and submit fingerprint cards. 6) After receipt of the CGFNS-CES report and English language proficiency, apply to take the NCLEX.
You will not receive your Authorization To Test (ATT) until the Board has received your CGFNS-CES Report , the results of your English Proficiency exam and valid proof of licensure in the country where you completed your nursing education program.
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Return to: Nevada State Board of Nursing, 5011 Meadowood Mall Way, Suite 300, Reno, NV 89502-6576 (888) 590-6726, fax (775) 687-7707, nursingboard@nsbn.state.nv.us www.nevadanursingboard.org To practice nursing in Nevada, you must hold an active Nevada license. License Type Registered Nurse Licensed Practical Nurse Application Type By Endorsement By Examination
First Name
Middle Name
Last Name
Social Security #
Telephone #
Date of Birth
Place of Birth
Address (if you move, you must notify the Board within 30 days in writing, or via the Board's website)
Apt. #
Male Female
City
State
ZIP
Email Address
If you wish to apply for a Nevada nursing license, please answer all questions, sign the application, and include the fee. Incomplete applications will be returned to you for completion.
It is a violation of Nevada law to falsify this application, and sanctions may be imposed for fraud or misrepresentation.
(Please list any previous last names used. Attach a separate piece of paper if necessary.)
2.
School
Date Graduated
Degree/Diploma
In what state?
You must indicate a date. Phrases such as TODAY, CURRENTLY, PRESENTLY, STILL PRACTICING, etc. will cause a delay in processing your application.
Have you taken the NCLEX examination in any other state(s)? Yes No
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Section 2. Application Screening Questions (If you answer Yes to any of Questions 1 through 5 below, you MUST submit the required documents to avoid delays in
processing your application.) Yes No 1. Has your occupational or professional license or privilege to practice, registration, or certificate of any level (does not include drivers license or car registration) a. Ever been denied? b. Ever been disciplined including but not limited to reprimanded, censured, fined, suspended, revoked, limited or restricted, or placed on probation or monitoring? c. Ever been subject to a non-disciplinary probation or monitoring program? d. Are you the subject of a current investigation or inquiry in any state or jurisdiction? e. Are you the subject of a pending hearing, settlement or action in any state or jurisdiction? If any answer is Yes, you must submit the following: a. A detailed letter of explanation that includes the state or jurisdiction where the action occurred or is pending and b. Copies of documents from the state or jurisdiction where there has been action, a current investigation or inquiry Yes No 2. Have you ever had a criminal conviction, including a misdemeanor or felony, or had a civil judgment rendered against you? If the answer is Yes, you must submit the following: a. A detailed letter of explanation including the circumstances leading to your conviction, date convicted, actual conviction (i.e. DUI, theft, etc.), what your sentence was, and if and when you completed it; b. Copies of court documents, including the actual conviction, sentence, and current status of sentence (i.e. all fines paid in full, completion letter from Parole/Probation Officer, etc.) or a letter/form from the court indicating no records are available; Yes No 3. Do you currently use chemical substances in any way which impairs or limits your ability to practice the full scope of nursing? If the answer is Yes, you must submit: a. A letter of explanation that addresses the impairment or limitations of practice; b. If you are using the chemical substance as a confirmed medical necessity, a letter from your treating practitioner documenting the diagnosis and medical necessity for the use of chemical substances, including any practice limitations. Yes No 4. Are you currently in recovery for chemical dependency, chemical abuse or addiction? If the answer is Yes, you must submit: a. A letter of explanation describing your recovery experience, including length of continuous recovery, treatment, and current recovery activities; b. Documentation from knowledgeable individual(s) documenting your length of sobriety; and c. Documentation of inpatient or outpatient chemical dependency treatment. Yes No 5. Do you currently have a medical or psychiatric/mental health condition which in any way impairs or limits your ability to practice the full scope of nursing? If the answer is Yes, you must submit: a. A letter of explanation regarding your condition, whether temporary or permanent, including diagnosis, past hospitalizations, date of last treatment, current treatment plan, and how your condition may interfere with your ability to practice the full scope of nursing safely; and b. Documentation from treating practitioner regarding the diagnosis, (Axis I-V for psychiatric diagnosis), medications, current status and treatment plan, the extent of condition, and statement regarding your ability to carry out nursing duties reliably and with good judgment.
(continued)
Affirmation
I affirm (swear) that I have read this application and the statements made are true and correct. Signature Date
Fee Schedule
RN by endorsement RN by examination LPN by endorsement 105.00 (includes $5 fee for 100.00 95.00 (includes $5 fee for
national database check)
LPN by examination 90.00 You may pay by credit card (MasterCard, Visa, Discover, American Express) personal or cashiers check, or money order, payable to the Nevada State Board of Nursing (NSBN). U.S. Funds only. Please note: If you do not submit the required fees, your application will be returned to you, unprocessed. All Fees are non-refundable.
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If Paying By Credit Card, Please Complete
Visa MasterCard Discover American Express Amount $ Card number Signature Exp. date
Name on card
NURSING
Nevada State Board of
Third-Party Authorization
If you would like someone other than yourself to act as your representative in the licensure process for this application, please complete this form and have your signature notarized. Discard this form if you are submitting the application for yourself and do not want another person to act on your behalf. I, __________________________________________, the undersigned, do hereby authorize ___________________________________ , whose address is _______________________________________________________________________, his/her agents or employees, to act for me and in my name with respect to my application for licensure with the Nevada State Board of Nursing, as follows: (Check only those items which apply) ________ 1. File my application ________ 2. Pay my application fee ________ 3. Act as my representative on all matters with the Board of Nursing
Date
Signature
State of
____________________________
by ______________________________________________________
5011 Meadowood Mall Way, Suite 300, Reno, NV 89502-6576 (fax) 775-687-7707 2500 W. Sahara Ave., Suite 207, Las Vegas, NV 89102-4392 (fax) 702-486-5803 www.nevadanursingboard.org 888-590-6726 nursingboard@nsbn.state.nv.us rev. 04-04-12