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The document specifies requirements for continuing education and CEU timing, personal information fields, employment verification through proof of paid work during the certification period, and a signature-based affirmation of accuracy. It also includes an affidavit of lawful presence with eligibility statements and detailed signing and perjury penalty guidance for Oklahoma applicants.","Nurse Aide Renewal Application  \nALL SECTIONS MUST BE COMPLETED IN FULL FOR APPLICATION TO BE PROCESSED  \nSection 1-Check the type(s) of Nurse Aide Certification(s) you want to renew.  \n☐ LTC – No Fee ☐ HHA- $10 Fee* ☐ ICF/IIDCA- $10 Fee* ☐ RCA- $10 Fee*  \n☐ ADCA- $10 Fee* ☐ Feeding Assistant (FA) - $10 Fee*  \nSection 2-Certified Medication Aide – Renewal  \n☐ CMA- $10  \n☐ Attach documentation of continuing education equivalent to eight (8) hours for every twelve months of certification, excluding the first year of certification.  \n**Continuing Education Units (CEUs) must be completed during the certification period or within one year after that.  \n***Advanced CMA certifications will be renewed at the same time as your CMA renewal. If you are requesting a new advanced CMA certification, please include the $10 fee for each one requested with the Advanced Training Application received from the course instructor.  \n\n| Section 3-Personal Information\u003Cbr> / / \u003Cbr>Date of Birth |  / / \u003Cbr>Social Security Number |\n| --- | --- |\n| First MI Last |  |\n| If you have had a name change since your last renewal, please include a certified copy of the marriage license or other court document which reflects the change of name when you submit this application. |  |\n| Current Mailing Address City State Zip\u003Cbr>E-mail address Telephone Number |  |\n\n\n| Section 4 – Employment Verification – Must submit proof of 8 hours paid work in nursing or nursing related services during the 24-month certification time frame. |  |\n| --- | --- |\n| ☐Administrative Signature OR ☐Paystub OR ☐Form W-2\u003Cbr>Facility Name\u003Cbr>Address City , State , Zip Code Phone Number | Start Date End Date\u003Cbr> / /  -  / /  Aide is still employed: ☐Yes ☐ No\u003Cbr>X  Administrative/HR Signature |\n\nSection 5 – Affirmation- I affirm the information on this form to be true and correct to the best of my knowledge.  \nX   / /     \nSignature of Nurse Aide Date Name of most recent Facility/Agency where employed – Phone  \nLTC Renewal only-NO Fee required: Email: [nar@health.ok.gov](nar@health.ok.gov), or Mail: NAR-OSDH, PO Box 268816, Oklahoma City, OK 73126-8816  \nRenewal(s) Requiring Fee(s): Make check/money order payable to: OSDH/Nurse Aide Registry  \nMail to: NAR-OSDH, P. O. Box 268816, Oklahoma City, OK 73126-8816  \nNOTE: All Fees submitted are NON-Refundable Total Enclosed $   \nAFFIDAVIT OF LAWFUL PRESENCE BY PERSON  \nMAKING APPLICATION FOR A LICENSE, PERMIT OR CERTIFICATE  \nI, the undersigned applicant, being of lawful age, state that one of the following statements is true and correct: (Check which of the following statements apply. )  \n I am a United States citizen.  \nOR  \n I am an approved alien under the federal Immigration and Nationality Act and am approved to be present in the United States. I understand that this approval may or may not include approval for employment. The issuance of a license, permit, or certificate issued by the Oklahoma State Department of Health is not authorization for employment in the United States.  \nWrite the identification number and the name of the authorizing document below.  \nAdmission/Registration \\#:   Authorizing Document:    \nI state under penalty of perjury under the laws of Oklahoma that the foregoing is true and correct and that I have  \nread and understand this form and executed it in my own hand.  \nDate   Signature    \nCity & State   Print Name   If applying to renew a license, permit, or certificate, please write the number:    \nCurrent license, permit, or certificate \\#  \nINSTRUCTIONS FOR USE OF THE AFFIDAVIT OF LAWFUL PRESENCE BY  \nPERSON MAKING APPLICATION FOR A LICENSE, PERMIT OR CERTIFICATE  \nThe person signing this form must read these instructions carefully.  \n1. If the person signing this form is receiving services and not making an application for a license, permit or certificate, this form should not be used but rather, either the form titled, “Affidavit of Lawful Presence by Parent or Guardian of Person Receiving Services” or the form ti","cbCaiigQC1qK6LBI","https://ap.wps.com/l/cbCaiigQC1qK6LBI","pdf",388983,7,3,"English","en",105,"# Section 1 - Certification Renewal Type Selection\n## LTC, HHA, ICF/IIDCA, RCA, ADCA, Feeding Assistant (FA)\n# Section 2 - Certified Medication Aide Renewal\n## CMA Renewal and Continuing Education Requirements\n# Section 3 - Personal Information\n## Name Change Documentation and Contact Details\n# Section 4 - Employment Verification\n## Proof of Paid Work and Administrative/HR Signature Options\n# Section 5 - Affirmation and Signature\n## Payment/Submission Instructions\n# Affidavit of Lawful Presence by Applicant\n## Eligibility Statements, Identification Information, and Perjury Penalties\n# Instructions for Use of the Affidavit of Lawful Presence","[{\"question\":\"What information must be completed before the nurse aide renewal application can be processed?\",\"answer\":\"All sections of the application must be completed in full for the application to be processed.\"},{\"question\":\"What continuing education requirements apply to medication aide (CMA) renewal?\",\"answer\":\"Provide documentation of continuing education equivalent to eight (8) hours for every twelve months of certification, excluding the first year. 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