Cognitive competency exam form 2025

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  1. Click ‘Get Form’ to open the cognitive competency exam form in the editor.
  2. Begin by entering your personal information, including your Registry Number, Social Security Number, and full name (Last, First, Middle Initial). Ensure that your mailing address, city, state, zip code, and email are accurately filled out.
  3. Complete the Felony Statement section by selecting 'YES' or 'NO' for each question. If you answer 'YES', be prepared to upload official documentation regarding the conviction.
  4. Fill in your Employer Information and indicate if you are requesting inactive status. Provide details about your CPR certification including the organization and expiration date.
  5. In the Verification of Skill Competence section, list your skills and knowledge areas as required. Make sure to provide accurate details for each skill listed.
  6. Finally, ensure all signatures are obtained where necessary: Physician Medical Director Signature, Registrant Signature, and Training Officer/Supervisor Signature. Each must be an original signature.

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Cognitive tests are short, quick tests to check how well your brain is functioning. These tests dont diagnose specific diseases. Instead, they identify a problem with cognition and the need for more in-depth testing. Brain Health Care. Find a Doctor and Specialists.
Example 1: 360-degree feedback 360-degree feedback is a form of competency testing in which multiple people, including an employees peers, supervisor, and team lead, give ratings and feedback on their performance.
Commonly used tests include: Montreal Cognitive Assessment (MoCA) test. This test takes about 15 minutes. It includes memorizing a short list of words, copying a drawing of a shape or object, and looking at pictures of animals and saying which animals you see.
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