Agencies
Services
Nurse Agency Licensing Act Application Checklist
Renewal Application Checklist
o Application signed and notarized
o Government issued Identification
o “ACTIVE” Business registration status in ILSOS
o Certificate of Insurance
o Supervising Registered Nurse credentials
o Attestation Form
o IDFPR Disciplinary Report Form
o HCWR Review Form
o Application Fee
o Contracts
New Application Checklist
o Application signed and notarized
o Government issued Identification
o “ACTIVE” Business registration status with ILSOS
o Certificate of Insurance
o Supervising Registered Nurse credentials
o Bylaws (if Corporation)
o Operating Agreement (if LLC)
o Articles of Organization
o Resume of Owners
o Employment Application for future nurse employees
o Skills Checklist for each category of nurse employees
o Policy and Procudure Manual
o Application Fee
o Contracts