Get the free Affidavit of Licensure - Oregon.gov - oregon

HEALTH LICENSING OFFICE 700 Summer St. NE, Suite 320, Salem, OR, 97301 Phones: 503-378-8667 Fax: 503-370-9004 www.oregon.gov/oha/hlo Email: HBO.info state.or.us Print Form Affidavit of Licensure Request

How to fill out affidavit of licensure

How to fill out affidavit of licensure:

1. Obtain the form: The first step in filling out the affidavit of licensure is to obtain the appropriate form. This can typically be done by visiting the licensing authority's website or contacting their office directly.
2. Read the instructions: Once you have the form, carefully read the instructions provided. The instructions will guide you on how to properly complete the affidavit and what information needs to be included.
3. Provide personal information: The affidavit of licensure will usually require you to provide your personal information, such as your name, address, contact details, and any relevant identification numbers (e.g., license number, social security number).
4. State licensing information: Depending on the purpose of the affidavit, you may be required to provide information about your license or professional qualifications. This may include details about your education, training, certifications, and any previous licenses held.
5. Attach supporting documents: In some cases, you may need to attach supporting documents to the affidavit. These can include copies of your license, educational degrees, training certificates, or any other documentation that supports your claim of licensure.
6. Notarize the affidavit: After completing the affidavit, it may need to be notarized. This means that you will have to sign the document in the presence of a notary public, who will verify your identity and witness your signature. Notarization is typically required to ensure the authenticity and legality of the affidavit.

Who needs affidavit of licensure?

1. Professionals seeking employment: Individuals who are applying for jobs or positions that require specific licenses or professional qualifications may be required to submit an affidavit of licensure. This affidavit serves as proof that the individual holds the necessary licenses or qualifications to perform the required duties.
2. License renewal or recertification: Some licensing authorities may request an affidavit of licensure when renewing or recertifying professional licenses. This is done to confirm that the individual still meets the requirements for their respective profession and is eligible to continue practicing.
3. Government agencies and regulatory bodies: Government agencies or regulatory bodies responsible for overseeing specific industries or professions may require individuals to provide an affidavit of licensure when applying for permits, grants, or other official authorizations. This ensures that the individuals seeking these authorizations possess the necessary licenses and qualifications to operate within the regulated industry.

In conclusion, filling out an affidavit of licensure involves obtaining the form, carefully reading the instructions, providing personal and licensing information, attaching supporting documents if required, and notarizing the document. This affidavit is often needed by professionals seeking employment, for license renewal or recertification, and when dealing with government agencies or regulatory bodies.

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What is affidavit of licensure?

An affidavit of licensure is a sworn statement confirming an individual's professional qualifications and licensing status.

Who is required to file affidavit of licensure?

Licensed professionals such as doctors, lawyers, nurses, etc., are required to file affidavit of licensure.

How to fill out affidavit of licensure?

To fill out affidavit of licensure, one must provide personal information, licensing details, and sign the document in the presence of a notary public.

What is the purpose of affidavit of licensure?

The purpose of affidavit of licensure is to confirm that the individual holds a valid professional license and is qualified to practice in their field.

What information must be reported on affidavit of licensure?

Information such as name, contact details, license number, issuing authority, expiration date, and any disciplinary actions must be reported on affidavit of licensure.