Nurse Aide Continuing Education
Resume:
Application for Nurse Aide Registration
First Name Middle Initial Last Name Previous Name
Mena Ismael
Date of Birth Last 4 Digits of Social Security Number 07/06/1989
Street Address
**** ******* dr aptA
City State Zip Code
Sterling Heights Michigan 48312
Phone Number
Email Address
************@*******.***
County
Kent
Applicant Information
Registration Option
[ ] New Registration (You have completed training and testing requirements in Michigan and would like to receive registration as a nurse aide.)
[X] Reciprocity (You have trained and tested in one of the Michigan approved states AND you are currently active and in good standing on any state’s nurse aide registry.) State
Illinois
Registration Number
NA
Is the status of your registration in this state currently active?
[X]
[ ]
Yes
No
Is your registration in this state currently in good standing with no substantiated allegations of abuse, neglect, or misappropriation?
[X]
[ ]
Yes
No
Reciprocity Details
Pay and Submit
E-SIGNATURE
By submitting my electronic application and entering my name below, I certify:
• All information provided in this document is true and correct to the best of my knowledge.
• I meet and will follow any applicable federal regulations, state regulations, and administrative rules.
• I understand that:
• Effective March 23, 2026, I must attest to completing at least 12 hours annually of continuing education within my renewal period in accordance with Rule 400.315.
• I must retain documentation demonstrating that I have completed a course/training that is relevant to nursing services and including, but not limited to, abuse, neglect, or care planning. The documentation must include the course name, location, hours of course, topic, and date completed to demonstrate compliance with Rule 400.315, if requested by the department for auditing purposes.
• I understand that a false statement or dishonest answer by me may be grounds for disciplinary action against my permit/registration or may be punishable by law.
• I understand that I am prohibited from employment in a covered facility under the Michigan Public Health Code if I have had a substantiated finding against me for abuse, neglect, and/or misappropriation of resident property.
• I understand that there is a non-refundable application fee of $40.00. First Name
Mena
Last Name
Ismael
[X] Accept
Submitted 03/12/2024 02:44 PM
Contact this candidate