RN Verification of Employment Forms


Please download and print the appropriate verification form based on your specialty. Upon completion of form, please upload to the Candidate Eligibility Review Request.

If you have any questions, please contact Casey Botkin at Casey.Botkin@sfdph.org, (415) 554-2916.

    – Ambulatory Care Nursing

    – Correctional Facility Nursing

    – Critical Care Nursing

    – Critical Care Training Program

    – Emergency Care Training Program

    – Emergency Nursing

    – General (Medical-Surgical, Perioperative and Psychiatric Training)
        (No experience verification required for this specialty)

    – Home Health Care Nursing

    – Informatics

    – Long Term Care Nursing-Geriatric Nursing

    – Medical-Surgical Nursing

    – Neonatal Intensive Care Nursing

    – Neonatal Training
        (No experience verification required for this specialty)

    – Occupational Health Nursing

    – Perinatal Nursing

    – Perinatal Training
        (No experience verification required for this specialty)

    – Perioperative Nursing

    – Psychiatric Nursing

    – Quality Management


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