The “Fresh Start Act”, Sections 73-77-1 et seq., Miss. Code Annotated, 2019, allows an individual with a criminal record to petition at any time for a determination of whether the individual’s criminal history disqualifies the individual from obtaining a license.
This is not an application for professional licensure, permit, certification or any privilege to practice a profession. Rather, it is solely a request for determination made pre-application as to whether you are disqualified from obtaining licensure to practice nursing home administration. You are not required to have begun or completed any professional training at the time of this request for determination.
A $25.00 fee must accompany this request for determination. The fee must be in the form of a certified check or money order made payable to the Mississippi State Board of Nursing Home Administrators.
By completing and submitting this form, you are representing that the information provided in this request for determination is complete and accurate. Any omissions or misrepresentations in this form may be considered in future administrative, civil, criminal or other actions.
Any determination by the Board pursuant to Sections 73-77-1 et seq., Miss. Code Annotated, 2019 is limited to the information you provide and whether you are disqualified at this time from obtaining a license or privilege to practice. This application does not guarantee or otherwise imply that your future application will be denied, granted or conditioned. The Board will make that determination at the time of your application for licensure or privilege to practice.