INSTRUCTIONS: ALABAMA APPLICATION FOR LICENSURE OF ANESTHESIOLOGIST ASSISTANT

The form discussed in this article is used to apply for Alabama licensure as an anesthesiologist assistant. This document can be obtained from the website maintained by the Alabama Board of Medical Examiners.

Alabama Application For Licensure Of Anesthesiologist Assistant Step 1: On the first blank line of section I, enter your full name.

Alabama Application For Licensure Of Anesthesiologist Assistant Step 2: On the second blank line, enter your home street address.

Alabama Application For Licensure Of Anesthesiologist Assistant Step 3: On the third blank line, enter your city.

Alabama Application For Licensure Of Anesthesiologist Assistant Step 4: On the fourth blank line, enter your state.

Alabama Application For Licensure Of Anesthesiologist Assistant Step 5: On the fifth blank line, enter your zip code.

Alabama Application For Licensure Of Anesthesiologist Assistant Step 6: On the sixth blank line, enter your place of birth.

Alabama Application For Licensure Of Anesthesiologist Assistant Step 7: On the seventh blank line, enter your date of birth.

Alabama Application For Licensure Of Anesthesiologist Assistant Step 8: On the eighth blank line, enter your sex.

Alabama Application For Licensure Of Anesthesiologist Assistant Step 9: On the ninth blank line, enter your Social Security number.

Alabama Application For Licensure Of Anesthesiologist Assistant Step 10: On the tenth blank line, enter your telephone number.

Alabama Application For Licensure Of Anesthesiologist Assistant Step 11: In section II, you must answer all questions by checking "Yes" or "No" as applicable. If you answer yes to any, you must attach an explanation.

Alabama Application For Licensure Of Anesthesiologist Assistant Step 12: In section III, document your education since graduating high school as instructed.

Alabama Application For Licensure Of Anesthesiologist Assistant Step 13: In section IV, document your employment activities since graduating high school as instructed.

Alabama Application For Licensure Of Anesthesiologist Assistant Step 14: In section V, list all states where you have been certified, registered or licensed or have applied for certification, registration or license as an anesthesiologist assistant.

Alabama Application For Licensure Of Anesthesiologist Assistant Step 15: Section VI is to be completed in the presence of a notary public. Print your name on the first blank line, then enter your signature and the date where indicated. The notary public will then affix their seal and provide all other information requested.