Nurse Aide - Nebraska Department of Health andamp; Human Services 2025

1. Click ‘Get Form’ to open the Nurse Aide application in the editor.
2. Begin by filling in your name in the designated fields for Last, First, and Middle names. Ensure clarity as this is crucial for your registration.
3. If applicable, provide any maiden names or previously used names in the next section.
4. Enter your mailing address accurately, including street address, city, state, and zip code.
5. Fill in your email address and telephone number for communication purposes.
6. Input your Social Security Number and Date of Birth as these are required fields.
7. Complete the sections regarding your training course details, including the facility name, location, total hours completed, and course completion date.
8. Indicate whether you have passed the exams and provide information about reciprocity from other states if applicable.
9. List any nurse aide employers from the past 24 months along with their contact information and dates worked.
10. Finally, review all entries for accuracy before signing and dating the form at the bottom. Once complete, save your document.

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