June 30, 2016
2016 CERTIFIED NURSE ASSISTANT RENEWAL
Pursuant to Public Law 29-71, Article 4, Section 4.11 which states, “nurse licenses shall be renewed biennially by September 30 of even numbered years”, you are advised to submit a renewal application for Nurse Assistant by August 5, 2016 to ensure ample time in processing your license to be mailed through United States Postal Service.
The renewal application is available at the Guam Board of Nurse Examiners’ website at www.gbne.org
Please ensure timely submission of the following:
- Complete application in blue or black ink and notarized (with seal and expiration of notary)
- U.S. Social Security Number is required for all applicants.
- Police Report/clearance from current place of residence dated within three (3) months of expiration date of current licensure.
- Court Report/Clearance from current place of residence dated with three (3) months of expiration date of current licensure.
- Certificate of CEU’s (15 CEU’s dated between October 1, 2014 – September 30, 2016)
- Recent 2X2 passport size photo signed and dated within three (3) months of expiration date of current licensure.
- Payment Record Form and receipt from the Treasurer of Guam ($25).
- Supporting statements/documents to any questions answered with a “Yes”.
- Document for change of name (marriage/divorce) if needed.
- Request for changes for personal details (address/email or phone number(s).
All licensed nurses are encouraged to register for the Emergency System for Advanced Registration for Volunteer Health Professionals (ESAR-VHP) program for disaster response nursing activities (see attachment).
Counter service hours are 8:00 – 11:00 a.m. and 1:00 – 4:00 p.m. Monday – Friday. Applications will be accepted at the Terlaje Professional Building, 194 Hernan Cortez Avenue, Suite 213, Hagatna, Guam or mail to: Health Professional Licensing Office, 123 Chalan Kareta, Mangilao, Guam 96913
Failure to receive the application for renewal shall not relieve the licensee of the responsibility for renewing the license by the renewal date. Licenses which are not renewed by September 30 of the renewal year will be assessed a $40 reinstatement fee in order to practice nursing on Guam.
Should need further information, please contact Board Secretary, Ms. Rosemary Carman at (671) 735-7405 or email her at firstname.lastname@example.org.
MARLENE M. CARBULLIDO, RN, MSN
Interim Executive Director