Training Program and Instructor Personnel Record Form ...

1 Training Program and Instructor Personnel Record Form InformationNew Jersey Office Of the AttOrNey GeNerAlDivision of Consumer AffAirsnew Jersey BoArD of nursingRevised 6/13 Homemaker-Home Health Aide2 Table of Contents Approval . Completion/Submission .. Jersey Office of the Attorney GeneralDivision of Consumer AffairsNew Jersey Board of Nursing124 Halsey Street, Box 47030 Newark, New Jersey 07101(973) 504-6430 Homemaker-Home Health Aide Training Program InformationOverviewTo. the. public,. the. New. Nursing.( as. the. Board ).after.

2 ,.and. ,. the. the. the. the. been. the. meet. the. the. ,. ,.a.. is. a. who,. a. ,. the..must ..and .the . ,. ,. :. Program Homemaker-Home Health Aide Training ..be ..care . the. ;.a. the. Health;.an. the. New. ;.or. a. an. the. at. least. 76. hours,.to. 16. a. for. not. The. 16. a. be. a. shall. not. The. a. shall.

3 Be. the. laws. the. to. the. ,. At. the. the. Board,. be. visit. to. the. The ..deny .or ..the ..not .meet .the ..seq ., .all .initial .. history background not. issue. a. homemaker-home ..any .applicant,.. , .until .the . file. in. the. Investigation,. ,.or. in. the. the. ,. ,. :.(973). :.(973). applicant ( ). :.an. Certification,.a. ,.an. be. the. Board .The. the. the. for. the. * If the applicant has disclosed on the Certification and Authorization form that he or she has been convicted of a disqualifying offense, the applicant must submit evidence of rehabilitation along with the application.

4 Failure to provide evidence of rehabilitation will result in automatic disqualification. Program coordinators should not submit an application if the applicant has been convicted of a disqualifying offense and has not attached evidence of ..of .the ..the .. Board History be. days. after. the. Program Approval The. be. the. following materials are approval fee.. this. fee. [$ ].is. ,.or. a. ,. Health Aide Training Program .in. the. (a. a. bachelor nursing.( ). ). in. the. school Registration.( ).number,. ,. The.

5 For the Homemaker-Home Health Aide Training the. ,.if. applicable.(example:. ,. ,. ). The. Personnel have. an. file. with. the. of. the. Program General RequirementsThe. ,. to. be. the. ,.are. ( .9) .as .is .the ..The . (s). ( ). Board,.in. writing,.prior. to. the. date. the. ,.if. there. are. any. ,. Program Completion/Submission After ..the .. ,. ; ; ;. ,. each. ,. the. Nursing .for. the. (Note:.The. );. The .completed..( .this .packet).with .each .applicant .and. : The application fee is The.

6 Be. the. the. ,. The ..the ..(for ..only) ..each ..to .the ..of .the.. The ..will .. of. the. must. be. the. school,.and. will. the. to. be. the. been. the. or. his. will. Board,. the. applicant,.in. writing,.of. any. the. applicant .to .the . : .. :.. homemaker-home health aide may be assigned to patient care after the submitting agency or school has been notified of the conditionally certified homemaker-home health aide s approval. An aide listed as disapproved may not be assigned to patient care until notified by the Board that the application has been Sponsor Responsibilities(a).

7 The. (b). The. the. least. two. the. school,.the. date. and. ,. the. the..name .of .the ..each ..an . ; The. for. each. be. offered:.$ ;. The. resume(s).of. the. (s)..The. Instructor ,.address,.education.(the. institution,.the. type. of. diploma,.the. year. ),. (the. employer address,.the. employment,. year,. the. job. title,. and. ),. ,. (c). The ..not, ..and ..the .Board,.make . (d). The ..Nursing,.at .least .two.

8 To .each . ,. (e). an. ,.the. any. change,.such. as. a. location,. dates,.at. least. one. to. any. such. (f). ,. ,. the. instruction,. ; ; an. ; each. include,. ,. ; ,. ;..the .student .the ..by .the . ;. Developing,. file. a. plan. for. ,. ,. ; An. ,. ,. ; (s).performance;. Program ,. ,. ,. ,. :(1). ;(2). ;(3). ;.(4). ;.and(5). The. each. New. (g). The. not. use. the. Coordinator and Instructor It .is .the ..the ..assist.

9 The ..the ..the .. both. ; ; The ..fill .in .the ..order .for .the . ; ,.2 ..in .size, .of .the .applicant .and .shoulders,.taken .no .more ..to ..the .Board,.must .be ..the ..Certification; ;. the. a. ( the. : .. :. ),. the. applicant must provide evidence of rehabilitation at the time the application is the applicant does not provide evidence of rehabilitation at the time the application is submitted, the applicant will be automatically The. both. the. the. ,. ; ;. The. be. the. to.

10 Advised that official documents (for example: certificates and 9renewal forms) mailed by the Board to an inaccurate address will not be the Postal ,. ,. The ..the.. will. mail. with. The ..an .applicant . ,.. ,. Content/Hour Allocation :. :. Training of transferring from another setting, Nurse Assistant ( ) or Homemaker-Home Health Aide ( ) :. (Institutional,. ) ( :. ) I. Unlicensed Assistive Personnel ( ) Curriculum Content Outline HoursRecommended Content/Hour Allocation Outlines III. Long -Term Care ( ) Recommended Hour Allocation Outline Curriculum Total Course Hours -Term Care Total Module Hours Total Course Hours of transferring from another setting as with.