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Kentucky Board of Nursing 312 Whittington Pky Ste 300 Louisville KY 40222-5172 Web Address kbn.ky. gov 502-429-3300 OR 800-305-2042 Fax 502-429-3311 VERIFICATION OF EMPLOYMENT ATTACHMENT 1 For employment outside of the state of Kentucky Complete this form ONLY if you are reinstating your RN/LPN Kentucky license. Applicant s Last Name print clearly Applicant s First Name print clearly Applicant s Maiden Name if applicable Social Security Number Employed as Date...
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