Scribd
Upload
42 views1 page

VOE Form - Application

This document is a verification of employment form for nursing students. It requests information about a student's employment as a licensed nurse such as employer name, dates of employment, and number of hours worked in the last 12-24 months. For new graduates, it asks for details of their nursing program such as dates of enrollment and completion, as well as their academic standing. The completed form is to be uploaded into an application portal to verify the student's employment experience.

Uploaded by

Makala Crutchfield
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
42 views1 page

VOE Form - Application

This document is a verification of employment form for nursing students. It requests information about a student's employment as a licensed nurse such as employer name, dates of employment, and number of hours worked in the last 12-24 months. For new graduates, it asks for details of their nursing program such as dates of enrollment and completion, as well as their academic standing. The completed form is to be uploaded into an application portal to verify the student's employment experience.

Uploaded by

Makala Crutchfield
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

College of Education and Health Professions

Eleanor Mann School of Nursing

VERIFICATION OF EMPLOYMENT FORM DATE: __________________________

The Eleanor Mann School of Nursing at the University of Arkansas, Fayetteville, requests Verification of Employment for
Student Name: ______________________________________________________________________________________________

Select the type of active license this nurse is practicing under:

LPN RN New or Upcoming RN Graduate


For the working RN/LPN:
The above name person has been/will be employed as a Licensed Nurse at:
Employer Name: ______________________________________________________________________________________
Employer Address: ____________________________________________________________________________________
Hire Date: _________________________________ Termination Date (if applicable): ___________________________

Select the appropriate account of hours worked as a licensed nurse in your organization within the last 12-24 months:

Employee has worked less than 1000 hours. # Hours worked: ____________________________________

Employee has worked 1000+ hours. # Hours worked: ____________________________________

Employee has worked 2000+ hours.

Employee is currently working: Full Time Part Time Other _________________________________________

For new or upcoming RN graduates:


The above named person is a student enrolled at:
Program Name: ____________________________________________________________________________
Program Address: ___________________________________________________________________________
Program Start Date: _________________________ Completion Date: ______________________________

Is the new or upcoming graduate in good academic standing? Yes No

__________________________________________ ______________________________________
Employer/Faculty Contact Name (print) Employer Contact Title

__________________________________________ ______________________________________
Employer/Faculty Contact Signature Contact Phone Number

**PLEASE UPLOAD THIS DOCUMENT INTO YOUR APPLICATION PORTAL ONCE COMPLETED**

You might also like