Texas Board of Nursing
Nurse Endorsement Application

Identification

You are applying for the Nurse Endorsement Application

A response is required for each question within this application. In order to avoid delays in the application process, please read each question carefully and provide accurate information.

On this page and throughout the application, the term "applied licensure type" or "Licensure Type" is used to reference the level of nursing, either Licensed Vocational Nurse or Registered Nurse, for which you are submitting this application.

List your legal name including suffix (Jr., Sr., III, Etc.)

Previous Texas Licensure(required)

Have you ever been licensed in the State of Texas for the Licensure Type you're applying for today?



Employment or Examination Timeline(required)

Have you practiced in the level of nursing for the applied licensure type, within the last four years or have taken and passed the appropriate licensure examination for the applied licensure type within four years?



Criminal History(required)

*For any criminal offense, including those pending appeal, have you:

  1. been arrested and have a pending criminal charge?
  2. been convicted of a misdemeanor?
  3. been convicted of a felony?
  4. pled nolo contendere, no contest, or guilty?
  5. received deferred adjudication?
  6. been placed on community supervision or court-ordered probation, whether or not adjudicated guilty?
  7. been sentenced to serve jail, prison time, or court-ordered confinement?
  8. been granted pre-trial diversion?
  9. been cited or charged with any violation of the law?
  10. been subject of a court-martial; Article 15 violation; or received any form of military judgement/punishment/action?

(You may only exclude Class C misdemeanor traffic violations or offenses previously disclosed to the Texas Board of Nursing on an initial or renewal application)

NOTE: Expunged and Sealed Offenses: While expunged or sealed offenses, arrests, tickets, or citations need not be disclosed, it is your responsibility to ensure the offense, arrest, ticket or citation has, in fact, been expunged or sealed. It is recommended that you submit a copy of the Court Order expunging or sealing the record in question to our office with your application. Failure to reveal an offense, arrest, ticket, or citation that is not in fact expunged or sealed may subject your license to a disciplinary order and fine. Non-disclosure of relevant offenses raises questions related to truthfulness and character. (See 22 TAC §213.27)

NOTE: Orders of Non-Disclosure: Pursuant to Tex. Gov't Code § 552.142(b), if you have criminal matters that are the subject of an order of non-disclosure you are not required to reveal those criminal matters on this form. However, a criminal matter that is the subject of an order of non-disclosure may become a character and fitness issue. Pursuant to Gov't Code chapter 411, the Texas Nursing Board is entitled to access criminal history record information that is the subject of an order of non-disclosure. If the Board discovers a criminal matter that is the subject of an order of non-disclosure, even if you properly did not reveal that matter, the Board may require you to provide information about any conduct that raises issues of character and fitness.





Pending Investigations(required)

*Are you currently the target or subject of a grand jury or governmental agency investigation?



Previous Discipline(required)

Has any licensing authority ever refused to issue you a license or ever revoked, annulled, cancelled, accepted surrender of, suspended, placed on probation, refused to renew a nursing license, certificate or multi-state privilege held by you now or previously, or ever fined, censured, reprimanded or otherwise disciplined you?



Mental Impairment(required)

*In the past five (5) years, have you been diagnosed with or treated or hospitalized for schizophrenia and/or psychotic disorders, bipolar disorder, paranoid personality disorder, antisocial personality disorder, or borderline personality disorder which impaired or does impair your behavior, judgement, or ability to function in school or work? (You may answer "No" if you have completed and/or are in compliance with TPAPN for mental illness OR you've previously disclosed to the Texas Board of Nursing and have remained compliant with your treatment regime and have had no further hospitalization since disclosure.)



Drug and/or Alcohol Treatment(required)

*Within the past five (5) years have you been addicted to and/or treated for the use of alcohol or any other drug?



Nurse Compact Declaration

In accordance with the Nursing Practice Act, section 304.001, art. 4 and 22 TAC 220.2, I declare that the State of (please select state from drop down menu) is my primary state of residence and that such constitutes my permanent and principal home for legal purposes. "Primary state of residence" is defined as the state of a person's declared fixed permanent and principal home for legal purposes; domicile. For residence outside of the U.S. or its territories, select "Foreign" from the drop down list.

*Pursuant to the Texas Occupations Code 301.207, information, including diagnosis and treatment, regarding an individual's physical or mental condition, intemperate use of drugs or alcohol, or chemical dependency and information regarding an individual's criminal history is confidential to the same extent that information collected as part of an investigation is confidential under the Texas Occupations Code 301.466. If you are licensed as an LVN in the State of Texas and are currently participating in the Texas Peer Assistance Program for Nurses you may answer "NO" to questions #4 and #5.

© 1999- Texas.gov | Contact Us | Privacy | About Texas.gov | Help