Submit New Application

Request to Become Employer in TMU© Application

Please complete this application to be listed as an employer in TMU© as an eligible employer to verify the employment of nurse aides for the renewal of their federal certification.   

In the Name field please enter the operating name of the facility or entity.  

The email address you enter will be the email which receives notification of pending verification requests.  This email can only be associated with a single facility or entity.  Please consider using a general email such as "hr@entityexample.org", to ensure continuity despite staffing changes.

For a facility to be entered into the system as an employer, it must meet the following criteria:
  • Nurse aides performed nursing or nursing-related services for pay
  • Nurse aides are under the supervision of an RN or LPN
Address
Mailing Address
Additional Facility Information
Employer Type
RN/LPN Supervision
Affidavit
I attest, under penalty of law, that the information provided above is truthful and accurate to the best of my knowledge and that knowingly providing false information or omitting information may result in denial of licensure, a fine of up to $10,000, or imprisonment not to exceed six years or both (Wis. Stat. § 946.32).
By Submitting
I hereby verify that I understand and agree with the statements contained herein and the above information is true and correct.