Confirmation of Nursing Employment for Reregistration - mn 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the 'Applicant Information' section. Enter your first name, last name, and middle name (if applicable). If you have no middle name, check the corresponding box.
3. Provide your complete street address, city, state/province, country, and zip/postal code. Ensure all information is accurate and clearly printed.
4. Input your birth date in the format mm/dd/yyyy and your Minnesota license number. Select your gender by checking either 'Male' or 'Female'.
5. Enter your email address and the last date of nursing practice. Specify whether this was through employment or volunteer work.
6. Sign the form legally at the designated area to confirm that all provided information is true and complete.
7. Send this form to an employer or appropriate verifier who can confirm your nursing practice.

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