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If you have not check the No box and you may continue to Section VI. Facility Name Employment Dates From To CNA APPLICANTS WHO DID NOT MEET RENEWAL REQUIREMENTS ONLY 6 REACTIVATION I have not completed one 1 or both of the renewal requirements listed above in questions 4 and 5 and wish to reactivate my CNA certificate by taking the Competency Evaluation see C on the reverse. If approved a Competency Evaluation approval letter will be sent to you ...
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