The Georgia Reinstatement Nursing form is an official application used by individuals seeking to reinstate their nursing license in the state of Georgia. This form requires applicants to provide essential information, including their personal details, reasons for the lapse in licensure, and proof of continuing education hours. To ensure a smooth process, it is crucial to complete the form accurately and submit it along with the necessary documentation.
If you're ready to start the reinstatement process, please click the button below to fill out the form.
The Georgia Reinstatement Nursing form is an essential document for licensed nurses seeking to reinstate their nursing license after it has lapsed. This form outlines the necessary steps and requirements to ensure a smooth reinstatement process. Applicants must carefully follow the instructions provided, as incomplete applications will not be processed. Key components of the form include a consent form for background checks, a non-refundable application fee of $150, and a detailed account of activities since the last renewal. Additionally, applicants must specify their reasons for failing to renew their license and provide proof of required continuing education hours. The form also emphasizes the importance of meeting specific educational criteria, including a minimum number of hours in accounting and auditing subjects. Furthermore, the application requires personal information such as the applicant's name, social security number, and contact details. A signed affidavit confirming the accuracy of the information provided is also necessary. By adhering to these guidelines, applicants can navigate the reinstatement process effectively and regain their nursing credentials in Georgia.
APPLICATION FOR REINSTATEMENT OF LICENSE
GEORGIA STATE BOARD OF ACCOUNTANCY
237 Coliseum Drive
Macon, GA 31217
Phone (478) 207-2440
www.sos.georgia.gov/plb/accountancy/
Please read the instructions carefully and be familiar with the laws and rules governing the practice of accountancy in the State of Georgia. Visit the following website for information: www.sos.georgia.gov/plb/accountancy/. Board Rule 20-10-.04 concerning reinstatement of licensure is enclosed within this application.
The Board cannot process incomplete applications. If any item is missing, incomplete or incorrect, your application cannot be reviewed by the Board. Please review the check list below and this application before you submit it to ensure that all information and documentation is complete and correct.
Consent Form for background check. This form must be completed, signed and returned with your application or your complete application will be returned.
Activities Since Last Renewal. Field must be completed. Answers could be: did not need, out of country, sick, etc.
Non-refundable application fee of $150.00 (check or money order) made payable to Georgia State Board of Accountancy
Reason For Failing To Renew. Field must be completed.
Required completed hours of continuing professional education for reinstatement.
See the table below on left for the required number of hours required for reinstatement of license. If you do not have the required hours, your complete application will be returned and you have 90 days from the date of the notification letter to re-submit the application without an additional fee.
CPE Requirements:
You are required to have obtained 40 hours of CPE per year, not to exceed 160 hours. You may be required to show proof of this only if randomly audited.
See Board Rule 20-11-.02 (1) for more information regarding CPE.
A minimum of 20% of total hours must be in accounting and auditing subjects and at least 80 hours must have been earned during the 24 months immediately preceding the date of the Reinstatement Application. (Reinstatement Application must be signed the date it is mailed.) For instance: If you sign the Reinstatement Application on 1/1/08, your 80 hours (with 16 hrs. in A&A) would be from 1/1/06 to 1/1/08. Hours earned in 2008 and 2009 may also be used for the 12/31/09 renewal year. CPE requirements must be completed before submitting the Reinstatement Application.
As information:
If your license lapsed 12/31/07, you may use hours from 1/1/06 and forward for all hours except for the recent 80 hours in the previous 24 months (with 20% in A&A).
If you license lapsed 12/31/05, you may use hours from 1/1/04 and forward for all hours except for the recent 80 hours (with 20% in A&A) in the previous 24 months.
C:\Users\dmickler\AppData\Local\Temp\22 Application for Reinstatement of License_6D05F61.doc
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For Board Use Only
Date of Review
Approved
Disapproved
Fee Paid
Check #
Date
Applicant #
Receipt
#
237 Coliseum Drive - Macon, Georgia 31217 - (478) 207-2440
www.sos.state.ga.us/plb/accountancy/
(Application will be returned if all questions are not answered)
Reinstatement Fee: $150.00 (Non-Refundable)
License Type
PLEASE PRINT OR TYPE
Certified Public Accountant
License No.
Date License Lapsed
1.Name on License
First
Middle
Last
2. SSN*
3. Date of Birth
*THIS INFORMATION IS AUTHORIZED TO BE OBTAINED & DISCLOSED TO STATE & FEDERAL AGENCIES PURSUANT TO O.C.G.A. SECTION 19-11-1 & O.C.G.A.SECTION 20-3-295, 42 U.S.C.A. SECTION 551 & 20 U.S.C.A.SECTION 1001.
4.Physical Address
Number and Street (P.O. Box not acceptable)Apt. No.City/StateZip
5.
Mailing Address
(if different than Street address)
Street, P.O. Box
Apt. No.
City/State
Zip
6.
Telephone Number Day
(
)
Telephone Number Evening
7.Present Employer
8.Business Address
Number and Street
City
State
9.Internet e-mail address
Since the date of your last renewal, have you been convicted of a felony or misdemeanor (other than a minor traffic violation), or entered a plea of guilty, nolo contendere, or sentenced under the “First Offender Act’, or been sanctioned by this or another state board or agency? If Yes, check below and attach copy of conviction, plea or sanction. DUI and DWI are not minor traffic offenses.
NO
YES
(If YES, attach a certified copy of conviction, plea or sanction)
ACTIVITIES SINCE LAST RENEWAL:
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REASON FOR FAILING TO RENEW:
APPLICANT AFFIDAVIT:
I hereby swear and affirm that all information provided in this application is true and correct to the best of my knowledge and belief. I further swear and affirm that I have read and understand the current state laws and rules and regulations of the Board for which I am applying for licensure and I agree to abide by these laws and rules.
By executing this affidavit under oath, as an applicant for a professional license, as referenced in O.C.G.A. § 50-36- 1, administered by the Professional Licensing Boards Division, the undersigned applicant also verifies one of the following with respect to his/her application for a public benefit (check one):
1)
I am a United States citizen. Please submit a copy of your current Secure and Verifiable
Document(s) such as driver’s license, passport, or document as indicated on the Board’s
website.
2)
I am not a United States citizen, but I am either a legal permanent resident of the United States or I
am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act with an
alien number issued by the Department of Homeland Security or other federal immigration agency.
Please submit a copy of your current immigration document(s) which includes either your Alien number or your I-94 number and, if needed, SEVIS number.
The undersigned applicant also hereby verifies that he or she is 18 years of age or older and has provided at least one secure and verifiable document, as required by O.C.G.A. § 50-36-1(e)(1), with this affidavit.
In making the above representations under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of O.C.G.A. § 16-10-20, and face criminal penalties as allowed by such criminal statute. I also understand that any failure to make full and accurate disclosures may result in disciplinary action by the Board for which I am applying for licensure.
Executed in
(city),
(state).
Signature of Applicant
Printed Name of Applicant
SUBSCRIBED AND SWORN BEFORE ME ON THIS THE
DAY OF
_, 20
NOTARY PUBLIC My Commission Expires:
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IMPORTANT: Please see the following for continuing professional education report & page 8 for copy of rule #20-10- 04.
CONTINUING PROFESSIONAL EDUCATION REPORT
NAME :
THIS PAGE MUST HAVE TOTALS FOR A & A HOURS AND ALL OTHER SUBJECTS HOURS. APPLICATION WILL BE RETURNED IF THESE COLUMNS ARE NOT COMPLETE. THE BOARD WILL NOT TOTAL YOUR CPE HOURS.
(See page 8 for copy of rule #20-10-.04 (REINSTATEMENT) effective January 25, 2001 for current requirement.) YOU ARE NOT REQUIRED TO SUBMIT DOCUMENTATION OF CONTINUING EDUCATION HOURS UNLESS YOU ARE AUDITED.
School, Firm or Organization Conducting Program
Title of Program or Description of Content
Principal Instructor
Dates Attended
Accounting & Auditing
All Other Subjects
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Sub Total Hours
TOTAL HOURS CLAIMED ABOVE 2 COLUMNS MUST BE COMPLETED
I certify under penalty of perjury to the truth and accuracy of all statements, answers and representations made in this report.
Signature
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OFFICE OF SECRETARY OF STATE
PROFESSIONAL LICENSING BOARDS DIVISION
Macon, Georgia 31217
(478) 207-2440
CONSENT FORM
I hereby authorize the State Board of Accountancy (“Board”) to receive any Georgia criminal history record information pertaining to me which may be in the files of any state or local criminal justice agency in Georgia.
Full Name (Print)
Physical Address
(P.O. Boxes NOT Accepted)
Sex
Race
Date of Birth
Social Security Number
One of the following must be checked:
This authorization is valid for 90/180/
(circle one) days from date of signature.
I,
give consent to the Board to perform periodic
criminal history background checks for the duration of my licensure with this state.
Special licensure provisions (check if applicable):
Working with mentally disabled
Working with elder care
Working with children
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APPLICANT: PLEASE CHECK THE FORM OF IDENTIFICATION BELOW THAT YOU POSSESS. RETURN THIS FORM ALONG WITH A COPY OF YOUR APPROPRIATE DOCUMENTATION.
Name
Secure and Verifiable Documents Under O.C.G.A. § 50-36-2
Issued August 1, 2011 by the Office of the Attorney General, Georgia
The Illegal Immigration Reform and Enforcement Act of 2011 (“IIREA”) provides that “[n]ot later than August 1, 2011, the Attorney General shall provide and make public on the Department of Law’s website a list of acceptable secure and verifiable documents. The list shall be reviewed and updated annually by the Attorney General.” O.C.G.A. § 50-36-2(f). The Attorney General may modify this list on a more frequent basis, if necessary.
The following list of secure and verifiable documents, published under the authority of O.C.G.A. § 50-36-2, contains documents that are verifiable for identification purposes, and documents on this list may not necessarily be indicative of residency or immigration status.
A United States passport or passport card [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]
A United States military identification card [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]
A driver’s license issued by one of the United States, the District of Columbia, the Commonwealth of Puerto Rico, Guam, the
Commonwealth of the Northern Marianas Islands, the United States Virgin Island, American Samoa, or the Swain Islands, provided that it contains a photograph of the bearer or lists sufficient identifying information regarding the bearer, such as name, date of birth, gender, height, eye color, and address to enable the identification of the bearer [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]
An identification card issued by one of the United States, the District of Columbia, the Commonwealth of Puerto Rico, Guam, the Commonwealth of the Northern Marianas Islands, the United States Virgin Island, American Samoa, or the Swain Islands, provided that it contains a photograph of the bearer or lists sufficient identifying information regarding the bearer, such as name, date of birth, gender, height, eye color, and address to enable the identification of the bearer [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]
A tribal identification card of a federally recognized Native American tribe, provided that it contains a photograph of the bearer or lists sufficient identifying information regarding the bearer, such as name, date of birth, gender, height, eye color, and address to enable the identification of the bearer. A listing of federally recognized Native American tribes may be found at: http://www.bia.gov/WhoWeAre/BIA/OIS/TribalGovernmentServices/TribalDirectory/index.htm [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]
A United States Permanent Resident Card or Alien Registration Receipt Card [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]
An Employment Authorization Document that contains a photograph of the bearer [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]
A passport issued by a foreign government [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]
A Merchant Mariner Document or Merchant Mariner Credential issued by the United States Coast Guard [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]
A Free and Secure Trade (FAST) card [O.C.G.A. § 50-36-2(b)(3); 22 CFR § 41.2]
A NEXUS card [O.C.G.A. § 50-36-2(b)(3); 22 CFR § 41.2]
A Secure Electronic Network for Travelers Rapid Inspection (SENTRI) card [O.C.G.A. §50-36-2(b)(3); 22 CFR § 41.2]
A driver’s license issued by a Canadian government authority [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]
A Certificate of Citizenship issued by the United States Department of Citizenship and Immigration Services (USCIS) (Form N-560 or Form N-561) [O.C.G.A. § 50-36-2(b)(3); 6 CFR § 37.11]
A Certificate of Naturalization issued by the United States Department of Citizenship and Immigration Services (USCIS) (Form N-550 or Form N-570) [O.C.G.A. § 50-36-2(b)(3); 6 CFR § 37.11]
In addition to the documents listed herein, if, in administering a public benefit or program, an agency is required by federal law to accept a document or other form of identification for proof of or documentation of identity, that document or other form of identification will be deemed a secure and verifiable document solely for that particular program or administration of that particular public benefit. [O.C.G.A. § 50- 36-2(c)]
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RULES OF THE GEORGIA STATE BOARD OF ACCOUNTANCY
20-10-.04 REINSTATEMENT
20-10-.04 Reinstatement. Amended.
(1)An application for reinstatement of an expired permit shall be accompanied by:
(a) A reinstatement fee of $150.00; and
(b)Evidence satisfactory to the Board, of the completion of continuing professional education as specified below:
1.Forty hours of continuing professional education for each year since the last renewal of the permit or since the initial issuance of the permit, whichever is less, up to a maximum of 160 hours.
2.At least twenty percent of the total hours required must be earned in accounting and auditing subjects.
3.At least 80 of the continuing professional education hours must have been completed during the 2-year period immediately preceding the date of application for reinstatement.
4.The hours required may be counted toward fulfilling the continuing professional education requirements for the next biennial renewal, if they were completed during the applicable period for renewal.
5.No carryover hours may be used to satisfy continuing professional education requirements for reinstatement of an expired permit.
(c)The Board may, however, accept in lieu of the continuing professional education requirements other evidence of continued competency including, but not limited to, the passing of an examination approved by the Board.
(2)In considering the application for reinstatement the Board may conduct an investigation of the applicant to determine, among other things, if the applicant engaged in the practice of public accountancy during the period that the applicant was not the holder of a live permit to practice public accountancy. Based on the results of that investigation, the Board may deny the application for reinstatement.
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Completing the Georgia Reinstatement Nursing form requires careful attention to detail. Each section must be filled out accurately to avoid any delays in processing your application. Once the form is completed and submitted, it will be reviewed by the Georgia State Board of Accountancy. Ensure that all necessary documents and fees accompany your application to facilitate a smooth reinstatement process.
The Georgia Reinstatement Nursing form is an application used by individuals who wish to reinstate their nursing license in the state of Georgia. It is essential for those whose licenses have lapsed and who want to return to practice. This form requires applicants to provide personal information, details about their previous license, and proof of continuing education hours.
When filling out the Georgia Reinstatement Nursing form, several key requirements must be met:
Inadequate or missing information can result in the application being returned, delaying the reinstatement process.
Applicants must complete a minimum of 40 hours of continuing professional education (CPE) per year, not exceeding 160 hours. Specifically, at least 80 of these hours must have been earned in the 24 months preceding the application date, with a minimum of 20% of total hours focused on accounting and auditing subjects. If you do not meet these requirements, your application will be returned.
If your application is incomplete, it will not be processed by the Board. You will receive a notification letter detailing what is missing or incorrect. You will then have 90 days from the date of that letter to resubmit your application without incurring an additional fee. It is crucial to review your application thoroughly before submission to avoid this situation.
Applicants must disclose any felony or misdemeanor convictions since the last renewal, excluding minor traffic violations. If applicable, you will need to attach a certified copy of the conviction or sanction. This transparency is vital for the Board to assess your eligibility for reinstatement.
To ensure a smooth processing of your application, follow these tips:
By adhering to these guidelines, you can enhance the likelihood of a successful and timely reinstatement of your nursing license.
Incomplete Application: Many applicants fail to fill out all sections of the form. If any part is missing, the Board cannot process the application. It's essential to review each section carefully.
Missing Consent Form: The consent form for a background check must be signed and included with your application. Omitting this form will lead to the entire application being returned.
Incorrect Continuing Education Hours: Applicants sometimes miscalculate their continuing professional education (CPE) hours. Ensure that you have the required 40 hours per year, with at least 20% in accounting and auditing subjects, and that these hours are from the correct timeframe.
Not Providing Required Documentation: If you have been convicted of a felony or misdemeanor, or sanctioned by another board, it’s crucial to attach the necessary documentation. Failing to do so can result in delays or rejection of your application.
Signature and Date Issues: The application must be signed and dated on the day it is mailed. Neglecting to do this can lead to processing delays or a complete return of your application.
When applying for reinstatement of your nursing license in Georgia, several additional forms and documents are commonly required. Each plays a crucial role in ensuring your application is complete and compliant with state regulations. Here’s a list of essential documents you may need to submit along with the Georgia Reinstatement Nursing form:
Make sure to review each document carefully before submission. Incomplete applications will be returned, causing delays in your reinstatement process. Ensure all forms are filled out accurately, and all required documents are included to facilitate a smooth application experience.
The Georgia Reinstatement Nursing form shares similarities with the Application for Reinstatement of License used by various professional boards, such as the Georgia State Board of Accountancy. This document requires applicants to provide personal information, including their name, social security number, and license details. It also mandates a non-refundable application fee and outlines the consequences of submitting incomplete applications. Both forms emphasize the importance of continuing education requirements, necessitating proof of completed hours prior to submission. This ensures that applicants maintain their professional competency.
Another document that resembles the Georgia Reinstatement Nursing form is the Application for Reinstatement of Medical License. This application is used by physicians seeking to regain their license after it has lapsed. Similar to the nursing form, it requires detailed personal information, a statement of continuing education, and a fee. Both applications also include a section for disclosing any legal issues that may affect the applicant's ability to practice. This helps maintain the integrity of the profession by ensuring that only qualified individuals are reinstated.
The Application for Reinstatement of Teaching Certificate is yet another comparable document. Educators who have let their certification lapse must complete this form to return to teaching. Like the nursing form, it requires proof of continuing education and a fee. Both applications also assess the applicant's background, including any legal issues that may impact their professional responsibilities. This process safeguards the educational environment by ensuring that teachers meet the necessary qualifications.
The Application for Reinstatement of Real Estate License also shares key features with the Georgia Reinstatement Nursing form. Real estate agents must submit this application to regain their license after it has expired. It requires similar personal information, a non-refundable fee, and proof of continuing education. Both forms emphasize the importance of maintaining up-to-date knowledge in their respective fields, which is crucial for public trust and safety.
The Application for Reinstatement of Professional Engineer License is another document with notable similarities. Engineers seeking to reinstate their licenses must provide personal information, proof of continuing education, and a fee. Both forms require applicants to affirm their understanding of the laws governing their professions. This ensures that reinstated professionals are not only qualified but also committed to adhering to industry standards.
Lastly, the Application for Reinstatement of Pharmacy License mirrors the Georgia Reinstatement Nursing form in several ways. Pharmacists must complete this application to regain their licensure after a lapse. Similar to the nursing form, it includes sections for personal information, continuing education, and legal disclosures. Both documents aim to ensure that reinstated professionals are equipped with the latest knowledge and skills necessary for safe practice.
When filling out the Georgia Reinstatement Nursing form, attention to detail is crucial. Here’s a list of what you should and shouldn't do to ensure your application is processed smoothly.
By following these guidelines, you can help ensure that your application is complete and ready for review. Taking these steps seriously can save you time and prevent unnecessary delays in reinstating your nursing license.
There are several misconceptions surrounding the Georgia Reinstatement Nursing form. Understanding these can help applicants navigate the process more smoothly. Here are six common misunderstandings:
This is not true. The Board cannot process incomplete applications. If any item is missing or incorrect, the application will be returned.
In fact, the application fee of $150.00 is non-refundable. Be sure to prepare your payment accordingly.
This is incorrect. All required CPE hours must be completed before submitting the Reinstatement Application.
Actually, a minimum of 20% of total hours must be in accounting and auditing subjects. Additionally, at least 80 hours must have been earned within the 24 months prior to applying.
This is misleading. Applicants must disclose any felony or misdemeanor convictions, excluding minor traffic violations, and provide documentation if applicable.
On the contrary, a consent form for a background check is required. This must be signed and returned with the application.
When filling out the Georgia Reinstatement Nursing form, it is essential to follow specific guidelines to ensure a smooth application process. Here are key takeaways to consider:
By keeping these key points in mind, applicants can better navigate the reinstatement process and increase their chances of a successful outcome.