ࡱ> BDA#` bjbj 4(Dlh($&h  "ccccccc ^ cD80hcvcc@d\cZ&  Y hlllD lll $   HYPERLINK "http://www.fau.edu"  INCLUDEPICTURE "http://nursing.fau.edu/newnursingsite/images/faullogonew.jpg" \* MERGEFORMATINET ý Christine E. Lynn College of Nursing ý Christine E. Lynn College of Nursing 777 Glades Rd Boca Raton, FL 33431 Telephone: (561) 297-3887, FAX (561) 297-3652 OATH AND AFFIRMATION FOR FACULTY: For Health Requirements for Nursing Practice Sites for Education or Research I attest that today I am in good health and free of communicable diseases since my last health examination results provided to the College of Nursing. I also attest that I have met the immunization requirements for the following communicable diseases: red measles, mumps, Rubella, and Varicella, and I have had the hepatitis B series or have provided a signed and dated waiver to the College. If I had a past positive tuberculosis screening test, I attest that I had a chest x-ray that showed no signs or symptoms of tuberculosis and submitted this data to the College. I attest that I have had no signs or symptoms of tuberculosis since that chest x-ray. _________________________________________ Signature of Applicant _________________________________________ Name of Applicant (Printed or Typed) STATE OF __________________ COUNTY OF __________________ I HEREBY CERTIFY, that on this day personally appeared before me, an officer duly authorized to administer oaths and take acknowledgments, ____________________, to me well known and known to me to the individual described in and who executed the foregoing Oath and Affirmation, and that he acknowledged before me that the Oath and Affirmation was his act and deed. 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