Illinois Administrative Code
Title 68 - PROFESSIONS AND OCCUPATIONS
Part 690 - NURSE AGENCY LICENSING ACT
Section 690.80 - Application for Employment, Assignment, or Referral
Current through Register Vol. 48, No. 38, September 20, 2024
Each licensee shall require an applicant to complete in writing an application form which contains, but is not limited to the following:
a) Name and address of the applicant with verification of the applicant's identity by means of a valid driver's license, Secretary of State's identification card, passport or other appropriate identification which includes a photograph of the applicant;
b) Written verification from the Department of Professional Regulation indicating the license and licensure status of a RN or LPN;
c) Written verification from the Department of Public Health that a CNA has been registered as having completed a course which has been certified by that agency;
d) Dates and places of the most recent previous employment references;
e) A statement completed within the last twelve (12) months, that the applicant: