Worker license application 2026

1. Click ‘Get Form’ to open the worker license application in the editor.
2. Begin by filling out the Demographic Information section. Clearly print your legal name, Social Security Number, and National Provider Identifier Number if applicable.
3. Provide your birth date and place of birth, followed by your current address. Ensure all contact information is accurate for future correspondence.
4. Answer the Personal Data Questions honestly. If you answer 'yes' to any question, be prepared to provide additional documentation as required.
5. List all licenses, certifications, or registrations you hold in other states in the Other License section. Attach necessary verification forms for each state listed.
6. Detail your educational background and professional experience in the respective sections. Be thorough and attach additional pages if needed.
7. Complete the AIDS Education and Training Attestation and Continuing Education Attestation sections as required.
8. Finally, sign and date the Applicant’s Attestation to confirm that all information provided is true and complete before submitting your application.

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