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VT Verification of Licensure Form 2014 free printable template

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Vermont Secretary of State Office of Professional Regulation rd 89 Main Street, 3 Floor Montpelier VT 05620-3402 www.vtprofessionals.org Verification of Licensure Form Licensee: Please complete this
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How to fill out VT Verification of Licensure Form

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How to fill out VT Verification of Licensure Form

01
Download the VT Verification of Licensure Form from the Vermont Secretary of State's website.
02
Fill in your personal information including your name, address, and contact details.
03
Provide details of your current and previous licensure status, including all states where you have been licensed.
04
Include your social security number and any other required identification information.
05
Sign and date the form to certify that the information provided is accurate.
06
Submit the form to the appropriate licensing board or regulatory agency along with any required fees.

Who needs VT Verification of Licensure Form?

01
Individuals applying for licensure in Vermont who are currently licensed in another state.
02
Professionals seeking to verify their licensure status for employment or educational purposes.
03
Those who have held a license in Vermont previously and need to reapply.
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Process Submit an application online and pay the fee. Request verification of licensure via Nursys from your original state of licensure and the state where you are currently employed. Provide a background check with fingerprints.
Step 1: When to submit your renewal application Renewal applications open 6 weeks prior to the expiration and a courtesy notification will be sent to the email address on file when your renewal opens. The renewal fee for a registered nursing license is $190.
Submit an application online and pay the fee. Request verification of licensure via Nursys from your original state of licensure and the state where you are currently employed. If these states do not participate in Nursys, you will need to contact that state's BON and request verification be sent to the Vermont BON.
Endorsement is a quick process if the out-of-state nurse has relatively recent experience. Vermont has a practice requirement: 50 days, or 400 hours, in two years or 120 days, or 960 hours, in the prior five.
Nursing applications and renewals are processed online via OPR's Online Services System - log in to apply, renew, update an application/license, check your status, request a verification, and more. Nursing license renewal is not contingent upon a completed background check.
Once you application has met the requirements, your license will be issued. Please allow 3-5 business days for processing.

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The VT Verification of Licensure Form is a document used to verify an individual's professional licensure status in Vermont.
Individuals who are applying for a new license or renewing an existing license in Vermont are required to file the VT Verification of Licensure Form.
To fill out the VT Verification of Licensure Form, individuals must provide their personal information, details of their current or previous licenses, and any disciplinary actions taken against them.
The purpose of the VT Verification of Licensure Form is to ensure that applicants meet the licensing requirements and to confirm the authenticity of their licensure.
The VT Verification of Licensure Form requires information such as the applicant's name, license number, type of license, issuance and expiration dates, and any disciplinary history related to the license.
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