Travel Nurse Licensing Application Checklist Form
Confirm your application packet is complete before submission. Use this checklist to ensure all required documents are included and up to date.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
State of License Application
*
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Other
Select License Type
*
Registered Nurse (RN)
Licensed Practical Nurse (LPN)
Advanced Practice Registered Nurse (APRN)
Other
Copy of Current Nursing License Included
*
Yes
No
Background Check Documentation Attached
*
Yes
No
Immunization Records Provided
*
Yes
No
CPR or BLS Certification Copy Included
*
Yes
No
Do any documents expire within the next 3 months?
*
Yes
No
Submit Checklist
Should be Empty: