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RENEWAL VIA OUT-OF-STATE EMPLOYMENT Application

Please read these directions completely prior to continuing online to complete this form. Your request for renewal cannot be processed if it is incomplete, illegible, or includes false statements.

Complete this form, upload the required documents, and pay the non-refundable processing fee of $25 through the secure credit card processing portal.

Completing this form requires an uploaded image of either:
  • a verification letter of work performed signed by your employer on the employer’s company letterhead, or 
  • a pay stub or a W-2 showing proof of at least 8 hours working as a Nurse Aide within the previous 24 months 
    • NOTE:  If submitting a W-2, please upload proof of work verification with your job title listed, such as:
      •  an image of your name badge with your job title listed, or
      •  a letter from your employer with your job title listed
You will be renewed on the Arkansas registry if you are qualified after the following is successfully completed:  
  • You have uploaded a signed letter verifying work on your employer’s company letterhead, a pay stub, or a W-2 from your out-of-state employer.
    • NOTE:  If submitting a W-2, please upload proof of work verification with your job title listed, such as a:
      •  Name badge 
      •  Letter from your employer
    • The non-refundable processing fee of $25 is included. 
Successful submission for Arkansas renewal can be verified by checking your status on the Arkansas NA Registry at https://ar.tmutest.com

Expedited Processing of your Renewal via Out-of-State Employment on the Arkansas Registry for Qualified Military Members
A ‘uniformed service member’ means:  
  • An active or reserve component member of the United States Air Force, United States Army, United States Coast Guard, United States Marine Corps, United States Navy, United States Space Force or National Guard
  • An active component member of the National Oceanic and Atmospheric Commissioned Office Corps
  • An active or reserve component member of the United States Commissioned Corps of the Public Health Service
 A ‘uniformed service veteran’ means:
  • A former member of the United States uniformed services discharged under conditions other than dishonorable.
Applicability for expedited processing of your renewal via out-of-state employment applies to the following members who upload their proof of service documentation. 
  • A uniformed service member stationed in the State of Arkansas; 
  • A uniformed service veteran who resides in or establishes residency in the State of Arkansas; 
  • The spouse of a uniformed service member or veteran who resides in or establishes residency in the State of Arkansas; 
  • The spouse of a uniformed service member who is assigned a tour of duty that excludes the uniformed service member’s spouse from accompanying the uniformed service member and the spouse relocates to the State of Arkansas; 
  • Or the spouse of a uniformed service member who is killed or succumbs to his or her injuries or illness in the line of duty, if the spouse establishes residency in the State of Arkansas.
 If you qualify under one of the applicable means listed above, please fill out the information on this application under Military Members and upload your required proof of service documentation. The processing of your request for renewal via out-of-state employment in the State of Arkansas will be expedited.  

Your application is not complete until the required information is included, then select “Send Application.”
Address
Recertification Information
Military Member Status
Employment Information
Affidavit
  • I have uploaded one of the following from my out-of-state employer:
    •  a signed verification letter verifying my work performed on my employer’s company letterhead, or
    • a pay stub showing proof of at least 8 hours working as a Nurse Aide within the previous 24 months from my out-of-state employer, or
    • a W-2 showing proof of at least 8 hours working as a Nurse Aide within the previous 24 months from my out-of-state employer.
      • NOTE:  If submitting a W-2, please provide proof of work verification with your job title listed, such as:
        • Name badge
        • Letter from your employer
  • I understand a non-refundable processing fee of $25 is included.
  • If I am a qualified military member that is requesting the expedited processing of my renewal via out-of-state employment, I have uploaded my required proof of service documentation.
I agree that if all the requested documentation is not submitted with this application, and I do not reply to any of D&SDT-Headmaster's *emailed requests within one (1) month of submitting my application, my application will be denied and I will need to resubmit a new application and repay the fee.
  • *NOTE: If you have an iCloud email, you may not receive our communications and you may need to call to check your status.
By Submitting
I hereby verify that I understand and agree with the statements contained herein and the above information is true and correct.
Application Fee $25.00
Non-Refundable. All fees are non-refundable.