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August1989.pdf
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August1990.pdf
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August1994.pdf
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August1996.pdf
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August1998.pdf
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August2001.pdf
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General_Interview.docx
YES NO Supervisor’s Name and Contact Number(s) Employment for Past Two Years: Employer #1 Position Dates of Employment Terminated YES NO Resigned in Lieu of Termination? YES NO Employer #2 Position Dates of Employment Terminated YES NO Resigned in Lieu of Termination? YES NO Employer #3 Position Dates of Employment Terminated YES NO Resigned in Lieu of Termination? YES NO Previous Complaint YES NO Outcome: Jurisdiction(s) Previous Discipline YES NO Explain: Jurisdiction(s) Describe the circumstances leading to the incident being investigated. 1
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General_Interview.pdf
YES NO Supervisor’s Name and Contact Number(s):_____________________________________________________________ ___________________________________________________________________________________________________ General Interview 1 Form created by: the NCSBN Discipline Effective Practices Subcommittee, December 2014 Board of Nursing: ______________________________ Employer #3 _______________________________________________________________________________________ Position: ___________________________________________________________________________________________ Dates of Employment: _____________________________________________________________________________ Terminated?
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July1999.pdf