This is only required for applicants licensed in another state, territory or country who are seeking licensure by endorsement in New York State.
- Section I: Complete this section in ink.
- Section II: Provide an accurate and complete record of your professional work experience in chronological order. Include the name and address of your employer, co-workers or colleagues who will attest to your experience. Sign and date the attestation and send the form to the Office of the Professions at the address at the end of the form
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