Application Instruction Guide for Trauma Nurse Specialist (TNS) Examination and Certification

Provide all applicable information requested on all three pages of the application. Missing information on the application will result in a delay of enrollment.

Part I – Application Category Information (Required)

1. Enter Profession Name - TNS for Trauma Nurse Specialist
   
   
2. Enter Profession Code - 603 for Trauma Nurse Specialist (TNS)
   
   
3. Enter $25 for the Trauma Nurse Specialist Fee (Fee must be in the form of money order, cashier’s check or group check and made payable to Continental Testing Services, Inc. (CTS). No cash or personal checks will be accepted.)

If an unexcused absence occurs, testing fee is forfeited and will not be refunded.

4. Appropriate Information Regarding Application
   
   
   1. Check box for first time application
      
      
   2. Check box for second time application

Part II – Applicant Identifying Information

1. Complete all information (Required)
   
   
2. U.S. Social Security Number (Required)
   
   
3. Permanent Mailing Address (Required)
   
   
4. Employment (Check off current employment) (Required)
   
   
5. Maiden Name (If Applicable)
   
   
6. Registered Nurses License Number
   
   
7. State of Current Licensure
   
   
8. Date Issued
   
   
9. Expiration Date
   
   
10. Race/Ethnicity
    
    
11. Place of Birth, City, State, Country (Required)
    
    
12. Date of Birth (Required)
    
    
13. Gender (Required)
    
    
14. Telephone Numbers (Work and Home) (Required)
    
    
15. E-mail Address
    

Part III – Education Information

1. Preliminary Education – (Check Yes or No for graduated high school or GED)
   
   
2. Further Education (Check highest level achieved)
   
   
3. Name of Last School Attended
   
   
4. Last School Location (Include City and State)
   
   
5. Date of Graduation (Month and Year)

Part IV – Record of Certification or Licensure Information

Individuals certified or licensed in a U.S. jurisdiction, a foreign country or province must state whether or not they have ever held licensure (either temporary or permanent) to practice as an EMS Professional (If applicable).

Part V – Record of Examination

Please complete if you have taken the exam for this profession. Failure to disclose examination attempt may result in denial of your application or other appropriate action.

Part VI – Personal History Information (Disclosure of this information is voluntary)

1. Criminal Offense Conviction (Check Yes or No) If yes, attach a certified copy of the court records regarding your conviction, the nature of the offense and date of discharge, if applicable, as well as a statement from the probation or parole office.
   
   
2. Felony Conviction (Check Yes or No)
   
   
3. Certificate of Relief from Disabilities by the Prisoner Review Board (Check Yes or No)
   
   
4. Performance Functions (Check Yes or No)
   
   
5. Denied or Discipline for a Professional License or Permit (Check Yes or No)
   
   
6. Discharged Other than Honorably Discharged from Armed Services (Check Yes or No)
   

Part VII – Examination Coding Information (Required)

1. Enter Test Center Code for the chosen test site from the Testing Site Legend.
   
   
2. Enter your training program site code. This code is provided by your TNS Course Coordinator.
   
   
3. Record the number of times you have taken this exam
   
   
4. Special Accommodations (Check Yes or No)

Part VIII – Child Support Information

Child Support Status - This information is required by law and signing certifies that all information is true and correct. Applications will not be processed unless check boxes are completed.

Part IX – Certifying Statements

The application must be signed and dated by the applicant, certifying that all information is true and correct. The signature of the TNS Course Coordinator is also required.*

*An application without the signature of the TNS Course Coordinator will not be processed.

APPLICATION SUBMISSION

THE COMPLETED APPLICATION AND TESTING FEE SHOULD BE SUBMITTED TO YOUR TNS COURSE COORDINATOR.

Upon verification of application, you will receive a confirmation letter from Continental Testing Services. The confirmation letter must be taken to the test site along with a government issued photo id such as a driver’s license or state identification card. Please arrive at the test site thirty (30) minutes prior to test time for check-in.

Applications, with instructions, can be found at www.idph.state.il.us/ems or www.continentaltesting.net.

If you need further assistance with this application, please contact Continental Testing Services (CTS) at 1-800-359-1313.