The Texas Nurse Aide Registry Form 5506-NAR is a crucial document for nurse aides seeking employment verification and recertification in Texas. This form requires the completion of personal information, employment history, and verification from an employer. For those ready to take the next step, fill out the form by clicking the button below.
The Texas 5506 Nar form, officially known as the Texas Nurse Aide Registry Form 5506-NAR, plays a crucial role in the certification and recertification process for nurse aides in Texas. This form is divided into two main sections: the first must be completed by the nurse aide, while the second requires verification from the employer. In Section 1, nurse aides are tasked with providing personal information, including their name, mailing address, and CNA certificate number, along with answering questions related to their employment history and any criminal convictions. It’s essential for nurse aides to ensure all information is accurate, as incomplete submissions will be returned without action. Section 2 focuses on employer verification, requiring a signature from the facility’s program director or the actual employer, along with notarization. This section confirms the nurse aide's employment and compliance with regulations. Additionally, the form emphasizes the importance of in-service education, which is necessary for maintaining certification. It also outlines the potential consequences of tampering with the form, underscoring the seriousness of providing truthful information. Ultimately, the Texas 5506 Nar form is not just a bureaucratic requirement; it is a vital document that supports the integrity and professionalism of the nursing workforce in Texas.
Texas Nurse Aide Registry
Form 5506-NAR
September 2021-E
Employment Verification
Section 1 (To be completed by Nurse Aide. Please read the following instructions before completing this form.)
•Complete all information in Section 1 and sign to verify that the information provided is correct.
•Obtain employer verification (Section 2). Form must be emailed to Texas Nurse Aide Registry at: [email protected]. To verify your
Certified Nurse Aide (CNA) certification, use the following link: https://emr.dads.state.tx.us/DadsEMRWeb/.
Note: A list of approved in-service education programs can be found at: https://hhs.texas.gov/nar-cbts or https://hhs.texas.gov/nar-approved-inservice. The Texas Nurse Aide Registry will return (without action) incomplete requests and requests without the required documents.
Name of Applicant (Last, First, Middle):
Maiden Name (if applicable):
Mailing Address (Street or P.O. Box):
City:
Social Security No.:
Email Address:
State:
ZIP Code:
Daytime Phone No. with Area Code:
Sex:
Date of Birth:
CNA Certificate No.:
Male
Female
Verification of requirements for Nurse Aide Recertification
Are you listed on the Employee Misconduct Registry (EMR) as unemployable?
Yes
No
Have you been found to have a conviction of a criminal offense listed in Texas Health and Safety Code, §250.006?
If yes, give date of conviction.
Have you completed 24 hours of in-service education in the past two years?
Note: In-service education requirements are subject to audit. Be prepared to submit in-service certificates if contacted by Texas Health and Human Services Commission (HHSC).
Have you completed an HHSC course in infection control and proper use of personal protective equipment (PPE) once each year
in the past 24 months?
Signature – Nurse Aide
Date
Section 2 (To be completed by the Employer – Instructions)
•This section must be completed by the facility program director, official keeper of records or actual employer.
•Notarize employer signature at the bottom of this section and return to nurse aide.
Employer Name or Company Name:
Daytime Area Code and Phone No.:
I certify that the individual named above is/was employed by me as a nurse aide and performed nursing/nursing-related services from
to
and that I am not aware of any disqualifying misconduct.
Comments:
Signature – Employer
Sworn and subscribed to me on this
day of
, 20
, in
County, in the state of
.
Signature – Notary Public
Date Commission Expires
Place Notary Seal or Stamp Here
Tampering with, or attempting to falsify, a government record such as a nurse aide certificate is a third-degree felony punishable by up to 10 years in prison and a $10,000 fine.
Page 2 / 9-2021-E
Address:
•Did you sign and complete all information in Section 1?
•Did your employer notarize his/her signature in Section 2?
Did you know?
•You can verify certificate status by using the following link: https://emr.dads.state.tx.us/DadsEMRWeb/.
•You can download forms from our website: https://hhs.texas.gov/doing-business-hhs/licensing-credentialing-regulation/nurse- aide-registry/nar-forms.
Email the completed form and required documents to the Texas Nurse
Aide Registry at [email protected]
With a few exceptions, you have the right to request and be informed about the information that the Texas Health and Human Services Commission (HHSC) obtains about you. You are entitled to receive and review the information upon request. You also have the right to ask HHSC to correct information that is determined to be incorrect (Government Code, Sections 552.021, 552.023, 559.004). To find out about your information and your right to request correction, please contact the Nurse Aide Registry at 512-438-2050.
Filling out the Texas 5506-NAR form is a straightforward process that requires careful attention to detail. This form is essential for nurse aides seeking recertification. Once completed, it must be submitted along with any necessary documentation to the Texas Nurse Aide Registry. Below are the steps to guide you through the process.
Once you submit the form, the Texas Nurse Aide Registry will process your application. If any part of your request is incomplete or lacks required documents, they will return it without action. Be prepared for potential follow-up regarding your in-service education requirements.
The Texas 5506 Nar form, also known as the Nurse Aide Registry Form, is primarily used for employment verification of Certified Nurse Aides (CNAs). This form ensures that CNAs meet the necessary requirements for recertification and allows employers to confirm the employment history of nurse aides. By completing this form, both the nurse aide and their employer provide essential information that supports the nurse aide's certification status.
Section 1 must be filled out by the nurse aide. The information required includes:
Additionally, the nurse aide must answer questions regarding their employment status, criminal history, and completion of required in-service education. It is crucial that the nurse aide signs this section to verify that all provided information is accurate.
Section 2 is to be completed by the employer, specifically by the facility program director, the official keeper of records, or the actual employer. This section requires the employer to certify the employment of the nurse aide, including the dates of employment and the services performed. The employer's signature must be notarized to validate the information provided. This step is essential for the form to be accepted by the Texas Nurse Aide Registry.
Once both sections of the Texas 5506 Nar form are completed, the nurse aide must email the form along with any required documents to the Texas Nurse Aide Registry at [email protected]. It is important to ensure that all information is accurate and that the form is complete, as incomplete requests may be returned without action.
It is important to understand that tampering with or attempting to falsify a government record, such as a nurse aide certificate, is a serious offense. This act is classified as a third-degree felony and can result in severe penalties, including imprisonment for up to 10 years and a fine of up to $10,000. Therefore, it is crucial to provide truthful and accurate information when completing the Texas 5506 Nar form.
When filling out the Texas 5506 Nar form, people often make mistakes that can delay their application or even result in rejection. Here are nine common errors to avoid:
By being aware of these common mistakes, you can help ensure that your application process goes smoothly and efficiently.
When submitting the Texas Nurse Aide Registry Form 5506-NAR, several other documents may be required or beneficial to include. These documents help ensure a smooth processing of your application and verify your qualifications as a Nurse Aide.
Including these documents can expedite your application process and help avoid delays. Ensure all information is accurate and complete before submission to the Texas Nurse Aide Registry.
The Texas Nurse Aide Registry Form 5506-NAR is similar to the Employment Verification Form used in various industries. This document serves to confirm an individual's employment history and qualifications. Much like the 5506-NAR, it typically requires the employee to provide personal information and for the employer to verify that the individual was employed, along with details about their role and duration of employment. Both forms aim to ensure that accurate employment records are maintained, which is essential for regulatory compliance and professional accountability.
Another document that shares similarities with the Texas 5506-NAR is the Background Check Authorization Form. This form is often required by employers to obtain permission to conduct background checks on potential employees. Similar to the 5506-NAR, it requires the applicant to provide personal information and consent for verification. Both documents are designed to protect the integrity of the workplace by ensuring that individuals meet the necessary qualifications and do not have disqualifying factors in their background.
The Credential Verification Form is also comparable to the Texas 5506-NAR. This document is used by various professional licensing boards to verify that an individual holds the necessary credentials for their profession. Like the 5506-NAR, it requires the applicant to submit personal details and for an authorized representative to confirm the accuracy of the information. Both forms play a critical role in ensuring that professionals are qualified to provide services in their respective fields.
Additionally, the Professional License Renewal Application shares similarities with the Texas 5506-NAR. This application is used by licensed professionals to renew their credentials, often requiring proof of continuing education and employment history. Both documents necessitate the submission of personal information and verification from an employer or educational institution. They ensure that professionals remain compliant with ongoing education and ethical standards in their fields.
The Affidavit of Employment Form is another document akin to the Texas 5506-NAR. This form is often used in legal proceedings to confirm an individual’s employment status. Similar to the 5506-NAR, it requires a sworn statement from the employer regarding the employee's job title, duration of employment, and any relevant details. Both documents serve as official records that can be used to establish an individual’s work history in various contexts.
Lastly, the Verification of Employment Form is comparable to the Texas 5506-NAR as well. This form is typically requested by lenders or other organizations to confirm an applicant's employment status and income. Like the 5506-NAR, it requires the employer to provide specific details about the employee's role and duration of employment. Both documents are crucial for ensuring that individuals are accurately represented in financial or professional situations.
When filling out the Texas 5506 Nar form, it's important to follow some guidelines to ensure your application is processed smoothly. Here are six things you should and shouldn't do:
Following these guidelines will help you complete the form correctly and avoid delays in your application process.
Misconception 1: The Texas 5506 Nar form is only for new applicants.
This form is also used for recertification of existing Nurse Aides. It ensures that all current requirements are met, not just for those applying for the first time.
Misconception 2: Employers do not need to notarize their signature.
Notarization is a required step for the employer's section of the form. Without it, the application may be considered incomplete and returned without action.
Misconception 3: You can submit the form without completing all sections.
All sections must be completed. Incomplete forms will be returned, delaying the certification process.
Misconception 4: You do not need to provide proof of in-service education.
Proof of 24 hours of in-service education within the past two years is mandatory. Be prepared to submit documentation if requested.
Misconception 5: The form can be submitted through regular mail.
The completed form must be emailed to the Texas Nurse Aide Registry. Submitting it by mail is not an option.
Misconception 6: The Texas Nurse Aide Registry does not verify criminal history.
The form requires disclosure of any criminal convictions. The Registry checks this information as part of the certification process.
Misconception 7: You can use any email address to submit the form.
The form must be emailed specifically to [email protected]. Using a different email address may result in non-receipt of your application.
Misconception 8: There are no consequences for falsifying information on the form.
Falsifying any information can lead to serious legal consequences, including felony charges. This is a significant risk that should not be taken lightly.
Filling out the Texas 5506-NAR form is an important step for nurse aides seeking employment verification and recertification. Here are some key takeaways to keep in mind:
Taking these steps seriously can help ensure a smooth process in verifying your employment and maintaining your certification. Stay informed and proactive!