NM BON Diversion Program                History and Assesment Logo
  • NM BON Diversion Program History and Assesment

    6301 Indian School RD NE Ste 701 Albuquerque, NM 87190 Office: 505.841.9091 Email : nmbon.diversion@bon.nm.gov
  • History and Assessment

    If questions do not apply type in NA
  • Employment History

  • Previous Employer

  • Nursing Experience/Licensure

  • Health History

  • Previous Diversion Involvemet

  • Past Criminal History

  • Family History

  • Self-History

  • I have reviewed and understand the following, located on the New Participant site:

    1. NM NURSING PRACTICE ACT, Diversion Program §63.21.29 NMSA
    2. The Diversion Brochure
  • By digitally signing below, I attest that all the information provided in this webform is true, accurate, and complete to the best of my knowledge. I understand that any false or misleading information may result in consequences as determined by applicable laws and regulations. I acknowledge that the digital signature is my legally binding electronic signature for this document

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