AR920390Z - Arkansas Department of Health - healthy arkansas 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in your EMS/Healthcare Affiliation and Supervisor's Name at the top of the form. Ensure this information is accurate as it is crucial for processing.
3. Complete your personal details, including Last Name, First Name, Middle Name, Maiden Name, Date of Birth, Race, Driver’s License Number, Sex, State of Issue, County, and Social Security Number. Use clear and legible typing or printing.
4. Provide your current mailing address along with your email address. This ensures you receive any correspondence regarding your application.
5. List all felony and misdemeanor charges accurately in the designated section. Include Date, Location, Description, and Sentencing/Disposition for each charge.
6. Select the appropriate options regarding your residency status in Arkansas and sign the form. Remember to date it as well.
7. If required, complete a fingerprint card with law enforcement assistance. Ensure no spaces are left blank except for specified areas.

Start using our platform today to fill out the AR920390Z form easily and efficiently!