The New York Nurse 1 form is an essential document required for individuals seeking licensure as a Registered Professional Nurse or Licensed Practical Nurse in New York State. This form must be completed accurately and submitted with a fee of $143 to the Office of the Professions. Ensure all information is provided to avoid delays in the review process.
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The New York Nurse 1 form is an essential document for individuals seeking licensure as either a Registered Professional Nurse or a Licensed Practical Nurse in New York State. This application process requires careful attention to detail, as it encompasses a variety of critical components that must be completed accurately. Applicants must submit the form along with a fee of $143, which includes both the application fee and the initial registration fee. Each section of the form is designed to gather vital information, from personal identification details, such as social security numbers and contact information, to educational backgrounds and previous licensure history. It is crucial that the name on the application matches exactly with other official documents to avoid delays in testing authorization. Additionally, the form includes questions regarding criminal history and professional conduct, which applicants must answer truthfully. Notably, notarization of the affidavit is required, emphasizing the importance of honesty in the application process. As applicants navigate through this comprehensive form, they must ensure that all required fields are filled out completely to prevent any potential setbacks in their journey to becoming licensed nursing professionals in New York.
The University of the State of New York
This Area For Department Use Only
The State Education Department
Nurse Form 1
Office of the Professions
Application for Licensure
Division of Professional Licensing Services
www.op.nysed.gov
All applicants for licensure must complete this form and submit it with the appropriate fee ($143) directly to
the Office of the Professions at the address at the end of this form. The $143 fee is the total of the application
fee ($70) plus the fee for your first registration period ($73). The application portion of the fee is not refundable.
You must answer all questions in ink (pen or printer) and provide all information requested unless otherwise
indicated. Failure to complete all required parts of the application will delay its review. You must sign and date
the Affidavit on this form in the presence of a Notary Public.
Check what you are applying for (check one):
Registered Professional Nurse
22
$143
ER
Licensed Practical Nurse
10
The name listed on your application for licensure, the name on your photo identification, and the name listed on your NCLEX application must ALL match EXACTLY. If your name does not exactly match in all instances it will delay your authorization to test (ATT), you may not be allowed to take the exam at your scheduled time and you may incur additional fees to test.
1.
Social Security Number
2. Birth Date
Month
Day
Year
(Leave this blank if you do not have a U.S. Social Security Number)
3.
Print Name
Last
First
5.
Telephone/Email Address
Daytime Phone
Middle
Home or
Business
Licensee business address, phone and email address are public information. Failure to
indicate business or home on this form for each item will deem it public information.
4.
Mailing Address
Area Code
Phone
(You must notify the Department promptly of any address or name changes)
Email Address (please print clearly)
Line 1
Line 2
Line 3
6. New York State DMV ID Number
City
(Driver or Non-Driver ID)
State
ZIP Code
(Leave this blank if you do not have a
Country/
New York State DMV ID Number)
Province
7.
Do you have a CGFNS record?
Yes
No
If "yes", enter your CGFNS Number:
8.
Name as it appears on degree or other credentials (if different from above)
9.
Have you ever applied for New York State licensure in any profession?
If "yes", in what profession(s)?
10.
Have you ever been found guilty after trial, or pleaded guilty, no contest, or nolo contendere to a crime
(felony or misdemeanor) in any court?
11.
Are criminal charges pending against you in any court?
12.
Has any licensing or disciplinary authority refused to issue you a license or ever revoked, annulled, cancelled,
accepted surrender of, suspended, placed on probation, refused to renew a professional license or certificate
held by you now or previously, or ever fined, censured, reprimanded or otherwise disciplined you?
13.
Are charges pending against you in any jurisdiction for any sort of professional misconduct?
14.
Has any hospital, licensed facility or clinical laboratory restricted or terminated your professional training,
employment, or privileges or have you ever voluntarily or involuntarily resigned or withdrawn from such association
to avoid imposition of such measures?
NOTE: If you answer "Yes" to any questions numbered 10-14, submit a letter giving a complete detailed explanation. Include copies of any court records including a Certificate of Disposition. If there are offenses in multiple courts, please provide the same for each action. In answering these questions, consider whether, pursuant to Executive Law § 296(16), you are required to report any arrests, criminal accusations, or dispositions of such arrests or criminal accusations. If the court can no longer provide documentation, you must request, from the court, a letter stating why they cannot provide the documents. While your application is pending, you must notify the Division of Professional Licensing Services if the answers to any of these questions have changed.
Nurse Form 1, Page 1 of 4, Revised 11/19
Completing the New York Nurse 1 form is a crucial step in the licensure process. It requires careful attention to detail to ensure all information is accurate and complete. Following these steps will help you fill out the form correctly and avoid delays in processing.
The New York Nurse 1 form is an application for licensure for nursing professionals in New York State. It is required for individuals seeking to become a Registered Professional Nurse or a Licensed Practical Nurse. The form must be completed and submitted with a fee of $143 to the Office of the Professions.
Applicants must provide various personal details, including:
Completing all sections accurately is crucial to avoid delays in processing.
The total fee for submitting the New York Nurse 1 form is $143. This amount includes a $70 application fee and a $73 fee for the first registration period. Note that the application fee is non-refundable.
If the name on your application does not match exactly with your photo ID and NCLEX application, it may delay your authorization to test. This can lead to additional fees and rescheduling of your exam. It is essential to ensure all names are consistent.
Yes, the application must be signed and dated in the presence of a Notary Public. This notarization confirms the accuracy of the information provided. Without this step, the application may be considered incomplete.
Inaccurate Name Matching: Ensure that the name you provide on the application matches exactly with your photo ID and NCLEX application. Any discrepancies can cause delays in your testing authorization.
Incomplete Social Security Information: If you do not have a U.S. Social Security Number, leaving that section blank is acceptable. However, if you do have one, be sure to include it accurately.
Failure to Sign in Front of a Notary: Remember that your application must be signed and dated in the presence of a Notary Public. Skipping this step can result in your application being rejected.
Omitting Required Fees: The application fee totals $143. Ensure you include the correct payment and understand that the application portion is non-refundable.
Neglecting to Report Criminal History: If you have ever been found guilty of a crime or have pending charges, it’s crucial to provide this information. Failure to disclose can lead to serious consequences.
Not Providing Complete Educational History: All educational institutions attended must be listed. Missing information can render your application incomplete.
Ignoring Child Support Obligations: Ensure you accurately report your child support status. Non-compliance can affect your ability to obtain a license.
Improperly Filling Out Immigration Status: Be sure to select the correct citizenship or immigration status. This section is vital for compliance with federal law.
Forgetting to Keep Copies: Always retain copies of your application and any supporting documents. This practice can be helpful for future reference or in case of disputes.
When applying for licensure as a nurse in New York, the Nurse Form 1 is a crucial document. However, several other forms and documents may accompany this application to ensure a comprehensive submission. Below is a list of these essential forms, each serving a unique purpose in the licensure process.
Completing and submitting these forms alongside the Nurse Form 1 will facilitate a smoother licensing process. Each document plays a vital role in ensuring that all necessary information is available for review, ultimately supporting the applicant's journey to becoming a licensed nurse in New York.
The New York Nurse 2 form serves a similar purpose to the Nurse 1 form, focusing on the licensure of nursing professionals in New York. Both forms require detailed personal information, including educational background and professional history. Like the Nurse 1 form, the Nurse 2 form also mandates notarization and includes questions regarding criminal history and professional misconduct. This ensures that applicants are thoroughly vetted before obtaining licensure.
The New York Nurse Form 3 is another document that parallels the Nurse 1 form. It is primarily used for license verification and requires information about previous licenses held in other states. Both forms emphasize the importance of accurate reporting and provide specific instructions on how to submit supporting documents. The Nurse Form 3 is often submitted alongside the Nurse 1 form to streamline the licensure process for applicants who have practiced in multiple jurisdictions.
The Application for Licensure as a Physician (Form 1) is similar to the Nurse 1 form in that it serves as a primary application for professional licensure in New York. Both forms require a fee and detailed personal information, including educational history and professional conduct. Additionally, both forms necessitate the completion of a notarized affidavit, ensuring the integrity of the information provided by the applicant.
The New York State Social Work License Application also shares similarities with the Nurse 1 form. Both documents require applicants to disclose their educational background and any prior disciplinary actions. They both include sections that require notarization, which serves to verify the authenticity of the applicant's statements. This process is crucial for maintaining professional standards across various fields.
The Application for Licensure as a Physical Therapist parallels the Nurse 1 form in its structure and requirements. Both applications require extensive personal and educational information, as well as a notarized affidavit. Additionally, both forms include questions regarding past criminal activity and professional misconduct, which are essential for evaluating an applicant's suitability for licensure.
The New York State Licensure Application for Occupational Therapy is another document akin to the Nurse 1 form. It requires applicants to provide detailed information about their educational credentials and any prior licenses held. Both forms also require notarization and include sections that address potential disciplinary actions or criminal history. This ensures that all applicants are subjected to the same rigorous standards.
The Application for Licensure as a Dentist in New York mirrors the Nurse 1 form in its comprehensive approach to applicant evaluation. Both forms require applicants to submit personal and educational details, as well as a notarized affidavit. Questions regarding criminal history and professional conduct are also present in both applications, emphasizing the importance of integrity in the licensure process.
The New York State Bar Application shares similarities with the Nurse 1 form, particularly in the need for detailed personal disclosures and notarization. Both forms require applicants to provide information about their educational background and any past disciplinary actions. The inclusion of questions related to criminal history in both applications underscores the commitment to maintaining ethical standards in the respective professions.
The Application for Licensure as a Veterinarian in New York is another document that aligns with the Nurse 1 form. Both applications require a thorough disclosure of educational history and professional conduct. Notarization is a common requirement, ensuring that the information submitted is accurate and truthful. Additionally, both forms include sections that inquire about past criminal activity, reinforcing the importance of ethical practice in the field.
Finally, the New York State Application for Licensure as a Massage Therapist is similar to the Nurse 1 form in terms of structure and requirements. Both forms necessitate detailed personal and educational information, along with a notarized affidavit. Questions regarding criminal history and professional misconduct are also included, highlighting the importance of integrity and ethical standards in obtaining professional licensure.
When filling out the New York Nurse 1 form, it is essential to follow specific guidelines to ensure a smooth application process. Here are some dos and don’ts to keep in mind:
This is incorrect. All applicants must pay a total fee of $143, which includes both the application fee and the first registration period fee. This fee is non-refundable.
This is not true. Applicants must answer all questions in ink and provide all requested information. Incomplete applications will delay the review process.
This is a significant error. The name on the application must match exactly with the name on your photo ID and NCLEX application. Any discrepancies can lead to delays in testing authorization.
This is false. The application must be signed and dated in the presence of a Notary Public. Failure to do so can result in denial of the application.
When filling out the New York Nurse 1 form, it’s essential to pay close attention to detail. Here are some key takeaways to ensure a smooth application process:
By following these guidelines, you can help ensure that your application is processed efficiently. Taking the time to double-check your information can save you from potential setbacks.