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RECIPROCITY FORM Application

Please read these directions before you complete and submit this form. Your request for reciprocity cannot be processed if it is incomplete, illegible, or includes false statements.

You are eligible for Reciprocity into New Mexico if you meet the following qualifications:

You must be current and in good standing on a nurse aide registry in a state other than New Mexico to be considered.
ALABAMA APPLICANTS: If you originally trained in Alabama more than two years ago and are only certified in Alabama, you must also include employment verification that you worked as a nurse aide under the direction of an RN/LPN during the previous two years.

Complete this form. Attach the required identification documents. Please note: Completing this form requires the following attachments:

Image of your valid US government-issued photo identification with your date of birth (state driver’s license, passport, or other signed current photo identification).
Image of your social security card. (You may use a letter from the Social Security Administration that notes both your name and SSN as a substitute for your SSN Card.)
For Alabama applicants, provide an image of your employment verification showing that you worked as a nurse aide under the direction of an RN/LPN during the previous two years.

You must have a valid email address to receive your TMU© login username and temporary password. You may check your listing on the New Mexico Nurse Aide Registry at nm.tmutest.com. Any personal information entered into TMU© will only be used to determine whether you can work as a nurse aide in New Mexico. Failure to provide complete and accurate information during the reciprocity determination process may delay or even prevent you from being listed on the NMNAR.

Your application is not complete until the required information is included, then select 'Send Application'.

Legal First Name

Middle

Legal Last Name

Suffix

Birthdate

Phone

SSN

Gender

Male Female Other

Address

City

State

Zipcode

Reciprocity Information

Reciprocity License Number If you have a license in another state, please provide your license number.

Reciprocity License State

Certification Select the certification type you are applying for.

IDENTIFICATION DOCUMENTS

Image of your valid US government-issued, signed photo identification showing your date of birth, such as: → state driver’s license, → passport, → or other signed, current, photo identification

Image of your Social Security Card You may upload an image of your letter from the Social Security Administration noting both your name and SSN as a substitute for your SSN Card.

EMPLOYER VERIFICATION

For Alabama applicants: please upload your employer verification that you worked as a nurse aide under the direction of an RN/LPN during the previous two years. If you worked in multiple facilities/locations, you may upload more than one employment verification.

Affidavit

I have uploaded my current US government-issued, signed photo ID that includes my date of birth.
I have uploaded my social security card or letter from the Social Security Administration noting my name and SSN.
If I am an Alabama Reciprocity applicant, I have uploaded employment verification.

I agree that if all the requested documentation is not submitted with this application, and I do not reply to any of *emailed requests within one (1) month of submitting my application, my application will be denied, and I will need to resubmit a new application.

*NOTE: If you have an iCloud email, you may not receive our communications, and you may need to call to check your status.

I understand that my application will be denied if:

Is unable to verify my registry status on another state's nurse aide registry.
If I have listed an offense on my application.

By Submitting

I hereby verify that I understand and agree with the statements contained herein and the above information is true and correct.