Section 690.80  Application for Employment, Assignment, or Referral

A nurse agency shall require each nurse or certified nurse aide applying for employment to complete an application.  Each application shall contain, but is not limited to, the following:

a)         Name and address of the nurse or certified nurse aide with verification of the nurse's or certified nurse aide's identity by means of a valid driver's license, state identification card, passport, or other appropriate government-issued photo identification;

b)         For nurses, written attestation that the nurse holds a license issued by the Illinois Department of Financial and Professional Regulation, including an attestation of the license held by the nurse and the nurse's licensure status;

c)         For certified nurse aides, written attestation that the certified nurse aide is certified by the Illinois Department of Public Health and that the certified nurse aide has been registered as having completed a course that has been certified by that agency;

d)         Dates employed, employer name, and contact information for the nurse's or certified nurse aide's most recent previous employment references, if applicable;

e)         An attestation completed within the last 24 months, stating that the nurse or certified nurse aide:

has completed a CPR training course provided by the American Red Cross or its equivalent.  The nurse's or certified nurse aide's date of CPR certification and the date of the certificate's expiration shall be indicated in writing on the application form, and the nurse or certified nurse aide shall maintain a copy of their current CPR certificate; and

f)         An attestation, completed within the last 12 months, stating that the nurse or certified nurse aide has completed a skill inventory and listed clinical areas of competence.

(Source:  Amended at 49 Ill. Reg. 6180, effective April 25, 2025)