A. Have you been previously licensed in nNw Jersey as Certified Homemaker Home Health Aide?

A. Do you currently have a child support obligation?

B. Have you failed to provide any court ordered health insurance coverage during the past 6 months.

C. Have you failed to respond to a subpoena relating to either a paternity or child-support proceeding

D. Are you the subject of child support related arrest warrant?

Are you currently engaged in the illegal use of controlled dangerous substances? (as stated above, “currently” is defined as “within the previous 365 days”)

Are you currently engaged in the illegal use of controlled dangerous substances? (As stated above, "currently" is defined as, "within the previous 365 days" ).

A. Have you enrolled or completed an HHA training program that has been sanctioned in the Board of Nursing?

B. Have you ever received a criminal summons, been arrested, taken into custody, indicted charged, tried by a judge or jury? Conditionally discharged or admitted into pre-trial intervention (PT) for, or pled guilty to any violation of law, ordinance, felony misdemeanor or disorderly person offense, in new Jersey or any other state the District of Columbia or any other jurisdiction?

C. Have you ever been convicted of any crime or offense under any circumstances?

D. Have you ever been convicted of any crime or offense under any circumstances? This includes, but not limited to, a pleas of guilty, non vult nolo condendeus, no content or a finding of guilty by a judge or jury?

A. Do you currently hold, or have you ever held, a professional license or certificate of any kind in a New Jersey, any other sate, the District of Columbia or any other jurisdiction?

B. Have you ever changed your name?

C. Have you ever been disciplined or denied a professional license or certificate of any kind in new Jersey, any other state, the District of Columbia or any other jurisdiction?

D. Have you ever had a professional license or certificate license of any type suspended, revoked or surrendered in New Jersey, any other state, the District of Columbia or in other jurisdiction?

E. has any action (including the assessment of fines or other penalties) ever been taken against your professional practices by any agency or certification board in New Jersey, any other state, the District of Columbia or in any other jurisdiction?

F. Have you ever been named as a defendant or any litigation related to the practice or nursing or other professional practice in New Jersey, any other sate, the District of Columbia or in any other jurisdiction?

G. Are you aware of any investigation pending against a professional license or certificate issued to you by a professional board in New Jersey, any other sate, the District of Columbia or in any other jurisdiction?

H. Have you ever been sanctioned by or is any action pending before any employer, association society, or other professional group related to, the practice of nursing or other professional practice in New Jersey, any other sate, District of Columbia, or in any other jurisdiction?