Consideration for LPN Appointment to the Oklahoma Board of Nursing - 2024

Thank you for your interest in serving on the Board of Nursing. The ONA Board will review your application and then submit a list of names to the Governor for consideration for appointment. This opportunity is for two Licensed Practical Nurse in District 1, 2, 3, 5, 6, 7 or 8 with one living in a county with a population less than 40,000.

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* 1. I'm a Licensed Practical Nurse.

Yes

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* 2. Which statute designated Geographical District do you live in?

District 1 - Cimarron, Texas, Beaver, Harper, Woods, Alfalfa, Grant, *Kay, Ellis, Woodward, Major, *Garfield, Noble, Dewey, Blaine, Kingfisher and *Logan;

District 2 - Roger Mills, Custer, Beckham, Washita, Caddo, Greer, Kiowa, Harmon, Jackson, *Comanche, Tillman and Cotton;

District 5 - Lincoln, Okfuskee, *Cleveland, *Pottawatomie, Seminole, Hughes, Pontotoc, Coal, Johnston, Marshall and *Bryan;

District 6 - *Creek and *Tulsa;

District 7 - *Osage, *Washington, Nowata, Craig, Ottawa, Pawnee,*Payne, *Rogers, Mayes and *Delaware; and

District 8 - *Wagoner, *Cherokee, Adair, Okmulgee, *Muskogee, Sequoyah, McIntosh, Haskell, *Leflore, *Pittsburg, Latimer, Atoka, Pushmataha, McCurtain and Choctaw.

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* 3. First Name

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* 4. Last Name

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* 5. Credentials

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* 6. Home Steet Address:

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* 7. City

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* 8. County

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* 9. State

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* 10. Zip Code

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* 11. Phone Number

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* 12. Email

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* 13. Present Nursing Position (title, employer, and city)

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* 14. I work in

Long Term Care

Acute Care

Other (please specify)

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* 15. List Professional and Community Activities

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* 16. Please provide a statement (100 words or less) of why you are interested in serving on the Oklahoma Board of Nursing.

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* 17. Are you able to meet deadlines and do so regularly and on time?

Yes

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* 18. Have you reviewed the Board of Nursing time commitment requirements and are able to meet them?

Yes

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* 19. Are you aware of the statutory grounds for removal from the Board? This includes not being employed in nursing for a period of 12 consecutive months during your term.

Yes

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* 20. Have you discussed your interest with your supervisor and received support from your organization?

Yes

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* 21. If you wish to submit your CV/Resume, please attach here.

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