VERIFICATION OF PENNSYLVANIA RESIDENCY - …
This form represents my request to enroll in a nurse aide training program and verification of Compliance with Act 14 – Nurse Aide Resident Abuse Prevention Training Act, 63 P.S. § 671 et seq. I have reviewed the list of Prohibitive Offenses Contained in 63 P.S. § 675 and hereby testify that I have not been convicted of ................
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