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Application For Licensed Practical Nurse Program HSETC 2024

Name

Main Phone

Race (Required For OSBI Background Check)

***Prospective applicants will receive consideration without discrimination because of race, creed, color, sex, national origin, or handicap if they can perform the necessary functions required for level of service. Race is required for OSBI criminal history.

Social Security Number

Address

Other Phone Numbers?

Date Of Birth

Emergency Contact & Your Relationship To Them

Please Write A Brief Statement (100-200 Words) Describing Why You Chose To Become A Licensed Practical Nurse

Please Supply High School And/Or College Transcripts Or GED Certification

NOTE: Every health care center in the State of Oklahoma is required by law to run a criminal background check through the OSBI on their new employee(s) who will be delivering direct patient care. The employer of a health care aide will be given a list of unlicensed convictions, if applicable, of the applicant for certain specified crimes when the criminal background check is done.