New York Licensing Information

Healthsource Global Staffing needs over 3,000 RNs for an upcoming strike in NY. You can make up to $5,300 or more if you work at this strike. We will help you get license and pay for the costs. We will be covering your airline tickets and accommodations in NY. You can't miss this strike, it will be professionally and financially rewarding and give you a chance to spend some time in Manhattan.

NEW YORK LICENSING FORM DOWNLOAD:

• Nursing Application Packet
• Form 11C NY Infection Control Training

Form 1: APPLICATION FOR LICENSURE (4 Pages)

Page 1:  Fill out all applicable fields

Page 2:  Fill out all applicable fields

Page 3: List ALL permanent RN licenses, including those that expired, check appropriate boxes

Page 4: Check 22 & 23: Attach exemptions* or certificates or if option 3 is checked--no attachments NOTARIZE Box 26

*Please note you can file for an exemption of the Child Abuse class if the nature of your practice excludes contact with persons under the age of 18 and persons 18 or older with a handicapping condition who reside in a residential care, school, or facility.

If not exempt, click on the course needed! Child Abuse and/or Infection Control.



Form 2: CERTIFICATION OF PROFESSIONAL EDUCATION (2 pages)

Page 1:  Fill out all applicable fields and include the school’s mailing address
Page 2:  Leave blank

If you mail directly to your school make a note for us!

A SEALED transcript will also fulfill this requirement and can be mailed to us instead of Form 2.




Form 3: VERIFICATION OF OTHER PROFESSIONAL LICENSURE/CERTIFICATION (2 pages)

Page 1: Fill out for every permanent license you have or ever had from the following states: CA, GA, HI, IL, KS MI, OK, PA, WV
(If you have a CA and GA license there will be two copies of page 1, one for CA and one for GA)

Page 2:  Leave blank (does not need to be sent)

Do not fill out Form 5: Application for a Limited Permit




Fill out reimbursement form, write your name on all receipts and staple them to the form

Mail Forms 1, 2, 3, and reimbursement form with attached original receipts to:

HealthSource Global Staffing
Attn: Licensing
39270 Paseo Padre Pkwy #138
Fremont, CA 94538

We are reimbursing you for
• Postage of the application to HSGS
• The fee for each required class (infection control and child abuse)
• License verifications (if done by the RN prior to mailing)
• Notary of the application

We are also paying the cost of
• NURSYS verifications
• Other license verifications
• Application fee