This form is an application for an established WV nurse aide to complete to apply to update his/her status on the registry if eligible

NOTE: Re-registration process may take up to two (2) weeks to complete from the date this office received the accurately completed application

This form is to be completed by the private duty/private pay employer for any and all private duty/private pay employment performed by a nurse aide prior to July 1, 2006. This form must be signed and notarized and submitted with the appropriate registration application (i.e, Re-registration, Reciprocity)

NOTE: Private duty worked on or after July 1, 2006 is not considered acceptable nurse aide employment for registration purposes

This form is an application for a nurse aide that is active and in good standing on another state nurse aide registry and is wishing to work in this state and gain active status on the WV Nurse Aide Registry.

This applicant must not be actively established on the WV Nurse Aide Registry or eligible for re-registration on the WV Nurse Aide Registry.