The New Mexico Board of Nursing Attestation of Expired/Lapsed License/Certificate is a formal document that individuals must complete when their nursing license or certification has expired or lapsed. This form serves to affirm the circumstances surrounding the lapse and requires the individual to disclose any work conducted under the expired license. Proper completion and timely submission of this form are essential to maintain compliance with state regulations and avoid potential disciplinary actions.
When filling out the New Mexico Board of Nursing form, keep these key takeaways in mind:
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Filling out the New Mexico Board of Nursing form can be a daunting task, especially for those who may be unfamiliar with the requirements. One common mistake individuals make is failing to provide a complete and accurate reason for allowing their license or certification to expire or lapse. This section is crucial, as it sets the context for the entire attestation. Omitting details or providing vague explanations can raise red flags and may lead to further scrutiny.
Another frequent error involves the selection of the appropriate attestation regarding work history during the period of expiration. Applicants must choose between attesting that they did not work or that they did work while their license was expired. Misunderstanding this requirement can lead to significant consequences. If an individual worked without a valid license and fails to disclose this information, it could result in disciplinary action. Therefore, careful consideration must be given to this section to ensure compliance.
Additionally, many applicants overlook the importance of providing complete contact information for their supervisor when attesting to work done on an expired license. This includes the supervisor's name, telephone number, and email address. Incomplete or incorrect information can hinder the verification process and may delay the resolution of the application. It is essential to double-check this information to facilitate smooth communication between the Board and the supervisor.
Finally, individuals often neglect to adhere to the specified timeline for submitting the attestation and supporting documents. The form clearly states that these materials must be returned within five business days following the renewal application submission. Failing to meet this deadline can result in disciplinary action against the license or certification. Understanding the importance of timely submission is vital for maintaining one's professional standing.
NEW MEXICO BOARD OF NURSING
ATTESTATION OF EXPIRED/LAPSED LICENSE/CERTIFCIATE
On this _________ day of _______________, 20______, I ___________________________, born on
(Print Name)
________________, swear and affirm as follows:
1.That I allowed my New Mexico License/Certification to expire/lapse. The reason for allowing this to occur is as follows:
______________________________________________________________________________
Attach additional documents if necessary.
2.Please answer either question A or B below:
a.I attest that I did NOT work any hours/shifts in the State of New Mexico or another compact State, since the date in which my license expired/lapsed: ___________.
(Initial)
OR
b.I attest that I DID work on an expired/lapsed license. __________.
i.Supervisors Name: _____________________________
ii. Supervisors Telephone: (
) ___________________
iii.Supervisors email Address: _____________________________
iv.Number of days/shifts worked in the State of New Mexico since the date in which my license expired/lapsed: __________________________
v.I have attached a list or payroll records of all dates and hours worked at a job related to my license/certificate from this day going back to the date when my license/certificate expired. ___________. (This also needs to be signed by your
supervisor).(Initial)
3.I understand this attestation as well as any supporting documents need be returned to the NMBON no later than 5 business days following the date of submission of my renewal application. Failure to provide this attestation within the time period required could result in disciplinary action taken towards my New Mexico licensure/certificate ___________.
I swear or affirm that the above and foregoing representations are true and correct to the best of My information, knowledge, and belief.
____________________
__________________________
______________
Print Name
Signature
Date
Any misrepresentation on this attestation can lead to disciplinary action and will be forwarded to the Compliance Division for investigation.
When submitting the New Mexico Board of Nursing form, individuals may also need to provide additional documents to ensure compliance with state regulations. Each of these documents serves a specific purpose in the licensing process and supports the attestation made in the primary form.
These documents, when submitted alongside the New Mexico Board of Nursing form, help to clarify the nurse's situation and facilitate the renewal process. Ensuring all required documents are complete and accurate can prevent delays and potential disciplinary actions.
When filling out the New Mexico Board of Nursing form, it is important to follow specific guidelines to ensure accuracy and compliance. Here are some key do's and don'ts:
Here are six common misconceptions about the New Mexico Board of Nursing form:
This is incorrect. The form must be completed by anyone whose license has expired or lapsed, regardless of whether they worked during that time.
In reality, you must return the completed form within 5 business days of submitting your renewal application. Delays can lead to disciplinary actions.
Even if you did not work, you still need to complete the form and affirm that you did not work during the lapse period.
This is false. If you worked while your license was expired, you must provide your supervisor's name, contact information, and a record of your shifts.
Misrepresenting information can lead to serious consequences, including disciplinary action and an investigation by the Compliance Division.
All forms must be signed to validate the information provided. A lack of signature can result in the form being rejected.