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Hospital Nurse Aide or Orderly Employment Training Requirement Waiver 1101 Application

You are eligible to bypass the Ohio STNA Training Requirement if you meet the following criteria: 1. You have the equivalent of twelve months or more of full-time employment within the preceding five years as a hospital aide or orderly. 2. An authorized representative of the hospital(s) where you work(ed) will verify your work history and can provide a job description.

Legal First Name

Middle

Legal Last Name

Birthdate

Phone

SSN

Gender

Male Female Other

Address

City

State

Zipcode

Required Documents

Work Verification A work verification letter on company letterhead from employer with dates and times outlining the 1600 hours worked in the preceding five years.

Job Description Job Description

Affidavit

You have the equivalent of twelve months or more of full-time employment within the preceding five years as a hospital aide or orderly,
An authorized representative has verified my work history and,
I have provided a job description.

By Submitting

I hereby verify that I understand and agree with the statements contained herein and the above information is true and correct.