Arkansas Nurse Aide Employer Form
Please complete this form to create or update an ar.tmuniverse.com employer account.  This account is used to verify the employment of nurse aides renewing their certification every two years.
Note: You must fill out a separate form for each location with a different email address to create the login.
If the contact changes, you can submit updates via this form or call D&SDT-Headmaster at (888)401-0462 to update.

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Employer Facility Name *
Please list the job duties certified nurse aides perform at your facility: *
Facility Address Including City, State and  Zip Code *
First and Last Name and Title of Employer Contact *
Phone Number of Employer Contact *
Email Address of Employer Contact *
Additional Comments:
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