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Office of Health Facility
Licensure & Certification

AMAP
RN ORIENTATION APPLICATION


Applicant Information
Facility/Agency Affiliation
Questions
Healthcare Employment
Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. If this application leads to being granted the privilege to take the RN Orientation course, I understand that false or misleading information on my application may result in this privilege being revoked and I may be reported to the WV RN Board.