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It records practice requirements, including hours worked as a nursing assistant (and Certified Medicine Aide where applicable), continuing education completion, and employment history across states. The form also requests disclosure of criminal convictions and disciplinary actions since the last renewal, with requirements for detailed explanations and certified court or regulatory documentation. 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If the answer is no, the applicant must complete and pass a Board-approved competency evaluation (CNA-I) or complete a Board-approved training program (CNA-II).","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"What additional information is required if the applicant answers “yes” to convictions or disciplinary actions since the last renewal?",{"text":114,"@type":110},"For Questions 5 and 6, the applicant must submit a detailed letter of explanation and court-certified true-test copies of relevant court documents. For Question 7, the applicant must submit a detailed letter of explanation and official copies of disciplinary documentation from the relevant regulatory body.",{"name":116,"@type":107,"acceptedAnswer":117},"When are the implicit bias and structural racism training attestations required?",{"text":118,"@type":110},"A certificate renewer must answer the implicit bias training attestation only for the first renewal after April 1, 2022. 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Governor ∙ Meena Seshamani, M.D., Ph.D., Secretary  \nRenewal Application for Nursing Assistant Certification  \nNursing Assistant Certification Program  \nCertificate Number:    \nLast Name:  First:   Middle:   \nHome Address:  \nStreet:   \nCity:  State:   Zip Code:   \nHome Phone:  Cell:   \nPersonal Email Address:   \nBusiness Address (optional):  \nStreet:   \nCity:  State:  Zip Code:   \nBusiness Phone:   \nBusiness Email Address:   \nGender: Male Female Other/ Unspecified (Select One)  \nSocial Security or Individual Tax ID Number:   \nDate of Birth: / /  Month / Day / Year  \nMarital Status: Single Married Separated Divorced Widowed (Select One)  \nEthnicity: Are you of Hispanic or Latino origin? (Select One) YES   NO    \nRace: Multiracial respondents may select all applicable racial categories below:  \no American Indian or Alaska Native  \no Asian  \no Black or African American  \no Native Hawaiian or Other Pacific Islander  \no White / Caucasian  \n4140 Patterson Avenue-Baltimore, Maryland 21215-2254  \nToll Free: 1 (888) 202 – 9861 • Phone: (410) 585 – 1900 • TTY/TDD: 1 (800) 735 – 2258  \n[www.health.maryland.gov/mbon](www.health.maryland.gov/mbon)  \nInterpreter Services are available upon request.  \nRenewal Requirements:  \n1. Have you actively practiced 16 hours as a nursing assistant , for compensation within the last two years?  \n  Yes   No  \nCNA-I: If you answer “no,” to question 1 , you must successfully complete and pass a Board-approved nursing assistant competency evaluation.  \nCNA-II: If you answer “no,” to question 1 , you must successfully complete a Boardapproved nursing assistant training program.  \n2. Question number 1 must be answered prior to completing this section.  \nA. Certified Medicine Aide only:  \nHave you practiced 100 hours as a Certified Medicine Aide in the last two years:   Yes   No  \nHave you completed the required 8-hour continuing education program in the last ninety  \n(90) days?  \n  Yes   No  \nCertification/Work Information:  \n3. Please list the other states where you are certified as nursing assistant (Active or Inactive): -Select One- -Select One- -Select One- -Select One-  \n4. Please list the places where you work:  \nIf you are employed, fill in the codes for all the places of employment, with your primary ( if any) employment listed first.  \nBackground:  \n5. Have you ever been convicted of or pleaded guilty or nolo contendere (this includes a guilty plea for which probation before judgment was received) to a misdemeanor?  \n Yes   No Since your last renewal?   Yes   No  \n6. Have you ever been convicted of or pleaded guilty or nolo contendere (this includes a guilty plea for which probation before judgment was received) to a felony?  \n  Yes   No Since your last renewal?   Yes   No  \n7. Has there been a disciplinary action taken against your license or certificate issued in any state, including Maryland?  \n Yes   No Since your last renewal?   Yes    \nIf you answered “yes” to any of the above “since your last renewal” questions, you must submit the following:  \nFor Questions 5 and 6 :  \na. A detailed letter of explanation, including the circumstances surrounding the crime, the date of your conviction or plea, the crime of which you were convicted or to which you pled guilty, your sentence, if and when you completed your sentence, and any other information you would like the Board to consider, such as subsequent work history, what you have learned, etc.; AND  \nb. Court certified or true-test copies of court documents regarding the facts and circumstances of the crime, your plea(s) or the disposition of your charge(s) , the sentence imposed, and current status of your sentence (i.e., all fines paid in full, completion letter from Parole/Probation Officer, etc. ), or a letter/form from the court indicating that no records are available. Examples of court documents that show factsand circumstances surrounding the crime include statement of probable cause/a","cbCaiuldbcB7Zn3C","https://ap.wps.com/l/cbCaiuldbcB7Zn3C","pdf",526826,"English","# Renewal Requirements\n## Practice hours and evaluations\n## Certified Medicine Aide requirements\n# Certification/Work Information\n## Other states certified\n## Places of employment\n# Background Disclosures\n## Misdemeanor convictions since last renewal\n## Felony convictions since last renewal\n## Disciplinary actions since last renewal\n# Attestations\n## Implicit bias training program\n## Structural racism training program\n# Attestation and Signature","[{\"question\":\"What practice and training requirements are needed for nursing assistant certification renewal?\",\"answer\":\"The applicant must have actively practiced 16 hours as a nursing assistant for compensation within the last two years. If the answer is no, the applicant must complete and pass a Board-approved competency evaluation (CNA-I) or complete a Board-approved training program (CNA-II).\"},{\"question\":\"What additional information is required if the applicant answers “yes” to convictions or disciplinary actions since the last renewal?\",\"answer\":\"For Questions 5 and 6, the applicant must submit a detailed letter of explanation and court-certified true-test copies of relevant court documents. For Question 7, the applicant must submit a detailed letter of explanation and official copies of disciplinary documentation from the relevant regulatory body.\"},{\"question\":\"When are the implicit bias and structural racism training attestations required?\",\"answer\":\"A certificate renewer must answer the implicit bias training attestation only for the first renewal after April 1, 2022. The structural racism training attestation is required only for the first renewal after April 1, 2026; otherwise the applicant should leave the section blank.\"}]","Renewal Application for Nursing Assistant Certification - Application Form | PDF",1789835390]