Transcription of Reactivation Applicant Checklist - Certified …
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Reactivation Applicant Checklist - Certified …
New Jersey Office of the Attorney GeneralDivision of Consumer AffairsNew Jersey Board of Nursing124 Halsey Street, 6th Floor, Box 45010 Newark, New Jersey 07101(973) 504-6430 Reactivation Applicant Checklist - Certified Homemaker-Home Health AidePlease place a check mark next to each category, sign and date this Checklist when submitting with your of Applicant : _____Social Security Number: _____ - _____ - _____ Review instruction sheet____ Application for Reactivation . Answer all questions where indicated. (pages 2, 3)____ Notarized Affidavit (page 4)____ Affidavit for Employer Verification (page 5)____ Employment Certification for the Reactivation of an Inactive Certification (pages 6, 7)____ All required fees are included along with a check or money order only (page 8)ALL QUESTIONS MUST BE FILLED IN WITH THE APPROPRIATE ANSWER OR THE LETTERS N/A (NOT APPLICABLE).
- 4 - Affix Seal Here} ss. AffidAvit Please identify any person other than the applicant who helped to prepare this form:
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