1 New Jersey Office of the Attorney General Division of Consumer Affairs New Jersey Board of Nursing 124 Halsey Street, Box 45010. Newark, New Jersey 07101. (973) 504-6430. CHHA Initial Certification Process Applicant Responsibilities The Board of Nursing has changed the Process for Homemaker Home Health Aide (CHHA) Certification . The Board is no longer accepting Eligibility Lists from Program Coordinators. Instead, each program graduate is required to submit his or her own application directly to the Board, along with all supporting documents.
2 It is crucial that programs educating HHAs continue to support them in completing the applications. The responsibility is shifting to the applicant who needs to provide the Board with the notarized application and all supporting documents. The Board will contact applicants directly if there are deficiencies. By way of reminder, each application must include the following: 1. a notarized application for Certification ;. 2. a 2 x 2 color passport photo;. 3. a copy of your birth certificate (English translation, if applicable).
3 4. proof of legal name change, if applicable;. 5. immigration documents, if applicable;. 6. criminal history documents, if applicable, 7. a signed promise of employment on official company letterhead from any agency approved to employ HHAs (HHAs can only work under the supervision of an RN, they cannot work as independent contractors); and 8. applicable fees in the form of a certified check or money order. Program Coordinator Responsibilities Instead of submitting Eligibility Lists, the Board is requiring program coordinators to e-mail a pdf file including a Graduate List, listing all individuals who successfully completed and graduated from the 76-hour Board-approved program.
4 The coordinators are required to also provide letters of completion for each program graduate for the approved program session. These documents can be scanned into one .pdf file and provided to the Board. Please e-mail the Board the name of the individual who will be providing this information to the Board. A Sample Graduate List (form) is included in this packet. Letters of completion are to be prepared on official program letterhead, signed by the Program Coordinator and stamped with the official school or business stamp, if available.
5 A sample letter of completion is included in this packet. The original copies are to be retained by the program. The pdf copies will be held by the Board pending receipt of the HHA's application. Promise of employment letters can be also scanned, if the program providing the education is also the employing agency. SAMPLE LETTER OF COMPLETION TEMPLATE. Date: New Jersey Board of Nursing 124 Halsey Street, 6th Floor Newark, New Jersey 07101. TO WHOM IT MAY CONCERN: This letter certifies that (insert full name of graduate) has completed the 76-hour New Jersey Board of Nursing- approved Homemaker Home Health Aide Course offered at (insert name of agency and approved location), from (insert start date) to (insert end date) by (insert the name of the approved instructor).
6 The last four digits of the graduate's Social Security number are ( 0000 ). The graduate's current address of residence is: (Street, City, Town, Zip Code). Should you have any questions please contact me at (insert an appropriate contact telephone number). My e-mail address is (insert business e-mail address). Sincerely, (Coordinator's signature). (Type in coordinator's name and credentials). Board approved Program Coordinator SAMPLE PROMISE OF EMPLOYMENT LETTER TEMPLATE. Date: New Jersey Board of Nursing 124 Halsey Street, 6th Floor Newark, New Jersey 07101.
7 TO WHOM IT MAY CONCERN: This letter certifies that (name of HHA) will be offered employment at (name and address of agency) as a HHA upon receipt of the 120 day work permit or Certification by the Board of Nursing. The last four digits of the graduate's Social Security number are: _____. The HHA's current address of residence is: _____. Should you have any questions, please contact me at: _____. Telephone number (Include area code). My e-mail address is: _____. Sincerely, _____. Name and Title 120-Day Period: Begins_____.
8 Ends_ _____. New Jersey Office of the Attorney General Division of Consumer Affairs New Jersey Board of Nursing 124 Halsey Street, Box 45010. Newark, New Jersey 07101. (973) 504-6430. Homemaker-Home Health Aide Training Program Graduate List Submitting agency/school_____. Site approval address_____. Street City State ZIP code County Telephone number _____ Fax number _____. (include area code) (include area code). Instructor's name_____ Program date: from _____ to _____. month/day/year month/day/year All names and addresses must be typed.
9 Do not complete the sections marked approved or disapproved. The New Jersey Board of Nursing will determine eligibility. Board Use Disapproved Approved Name (last name, first name, middle Initial ). Address Board Use Disapproved Approved Name (last name, first name, middle Initial ). Address I hereby certify that the above-listed individuals have successfully completed the Homemaker-Home Health Aide Training Program which consisted of 60 classroom hours and 16 hours of clinical practice. I hereby certify that I will ensure that the foregoing list is not altered, changed or tampered with in any way after it has been stamped and approved by the Board of Nursing.
10 I further certify that I will not release this list containing confidential student information to any third party pursuant to the Buckley Act. _____ Name of Program Coordinator (Bachelor of Science in Nursing) Signature Date Official Use Only If you have ever held Certification Board of Nursing as a homemaker-home health Candidate's Number aide in New Jersey , you should not fill out this application. _____. You should instead fill out the 120-Day Period: _____. Application for Reinstatement Begins_____ of a Homemaker-Home Health Ends_____ New Jersey Office of the Attorney General Division of Consumer Affairs Aide Certification which may be Please note that your criminal history New Jersey Board of Nursing obtained from the Board.