How to Get a CNA License: A Step-by-Step Guide

How to Get a CNA License

Getting a CNA license involves seven distinct steps: confirming eligibility, enrolling in a state-approved program, completing pre-training health clearances, finishing your clinical hours, applying for the competency exam, passing both parts of that exam, and getting listed on your state’s Nurse Aide Registry. The full process takes most candidates 8 to 14 weeks.

This guide walks through every step in order, including two things most guides skip: the challenge exam pathway for candidates with prior healthcare training, and what to actually do in your first 90 days after certification.

By Sarah, Career Advisor at CNAJobPath.com

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CNA License vs. CNA Certification

The phrase “CNA license” is used widely, but technically CNAs receive a certification rather than a license. A license is an ongoing regulatory permission issued by a state board. Certification, as used here, means you demonstrated competency through a state-approved training program and a standardized exam, and your name has been placed on your state’s Nurse Aide Registry.

That registry entry is your credential. It is a publicly searchable government database that every employer is legally required to check before placing a CNA in a patient care role in a Medicare- or Medicaid-certified facility. Your active registry status is what makes you employable as a nursing assistant, not a physical card, though some states issue those too.

Your certification is state-specific. If you move, you will need to apply for recognition in your new state through a process called reciprocity, which is covered later in this guide.

Step 1: Confirm You Meet the Basic Eligibility Requirements

Before enrolling in a program, verify that you meet your state’s eligibility criteria. While requirements vary, most states share a common baseline.

Age: Most states set the minimum at 18. Some allow candidates as young as 16 with parental consent. A small number of states allow high school students to complete CNA training through career and technical education programs. Check your specific state before assuming.

Education: A high school diploma or GED is required in most states, though not all. California does not require a diploma or GED for CNA candidates. Even in states that do not formally require it, employers in competitive markets will care.

Background check: Required in every state. In many states, fingerprint-based screening is a prerequisite before clinical training begins, not just before certification. Certain criminal convictions can disqualify a candidate from certification, particularly those involving abuse, neglect, or misappropriation of property. If you have a criminal history, contact your state’s Nurse Aide Registry before enrolling in a program to understand how it may affect your eligibility.

Health clearance: Most programs and facilities require a negative TB test, current immunizations (hepatitis B, MMR, varicella), and in some states a general physical before clinical hours can begin. Failure to complete these before your clinical start date will delay training.

Work authorization: Legal authorization to work in the United States is required in all states.

Step 2: Enroll in a State-Approved Training Program

This is the most consequential decision in the certification process. Your training program must be approved by your state’s health department or Board of Nursing. Completing a non-approved program means you will not be eligible to test, regardless of what the curriculum covered.

State-approved programs are offered through community colleges, vocational schools, nursing homes and long-term care facilities, hospitals, the American Red Cross, and hybrid online-plus-in-person formats. For a full breakdown of each type with cost and scheduling tradeoffs, see the CNA Training overview.

One thing I have seen cause real problems: a student who enrolled in a bridge program based on the advertised 14-month completion time. After enrollment, she discovered that the 14 months assumed all prerequisites were already complete. Her prerequisites — anatomy, physiology, microbiology — added another 18 months of community college work before she could even start the program. Total time: 32 months, the same as an ADN from scratch, at higher cost. Before you enroll, ask what the program assumes you already have, not just how long the program itself runs.

Federal law (OBRA ’87) sets the national minimum training requirement at 75 total hours, with at least 16 supervised clinical hours. Most states require more. Selected state requirements:

State	Minimum Required Hours
Texas, Colorado, Ohio	75 hours
Florida, Illinois	120 hours
Maryland	100 hours
Alaska	140 hours
California	160 hours
Maine	180 hours

The Challenge Exam: An Alternative for Some Candidates

Most guides skip this entirely. Some states allow candidates with documented prior healthcare training to sit for the competency exam without completing a full state-approved training program. This is called the challenge exam or exam exemption pathway, and it is relevant to a specific group of candidates.

Who may be eligible: military medics and corpsmen, paramedics and EMTs, home health aides with documented training hours, and in some states, candidates whose CNA certification has expired within a defined window. Eligibility criteria vary significantly by state. Some states permit this pathway broadly; others have eliminated it entirely.

The practical steps if you think this applies to you:

Contact your state’s Nurse Aide Registry directly and ask specifically about the exam exemption or challenge pathway
Request the documentation requirements in writing: what training records, military documents, or employer letters they need
Do not assume your training qualifies until the state confirms it in writing

If your state offers this pathway and you qualify, you can skip the training program entirely and go directly to scheduling the competency exam. That saves weeks and several hundred dollars. Worth a phone call to find out.

Step 3: Complete Pre-Training Requirements

Most states require health and background clearances before you can begin, or at minimum, before your clinical hours start. These include:

A fingerprint-based criminal background check (processing takes 1 to 3 weeks in most states)
A TB skin test or IGRA blood test (results take 48 to 72 hours to read)
Current immunizations: hepatitis B, MMR, varicella
CPR and Basic Life Support (BLS) certification — American Heart Association BLS for Healthcare Providers is the most widely accepted format
In some states, a physical examination before clinical placement

These can mostly be completed in parallel. Starting your background check application the same week you schedule your TB test prevents both from becoming bottlenecks. The single most common avoidable delay I see: candidates who complete their program enrollment and then wait for the program to tell them what to submit. Start everything the moment you confirm your enrollment.

Step 4: Apply for the CNA Competency Exam

Once you complete your approved training program, you apply for the state competency exam. Most programs will guide you through this process, or initiate it on your behalf.

Depending on your state, the exam is administered by Pearson VUE, Prometric, Credentia, or directly by a state agency or university. You will submit training completion documentation, a valid government-issued ID, and in most states an application fee. Once your application is approved, you will be given access to schedule your exam at an approved testing center.

Most states require you to pass the exam within a window of 12 to 24 months after completing training. If you do not test within that window, you may need to repeat portions of your training. Schedule your exam promptly after program completion. There is no advantage to waiting, and exam performance is highest when training is fresh.

Step 5: Pass Both Parts of the Competency Exam

The exam has two components. Both must be passed. Many states allow up to three attempts per section within your testing window. You retake only the section you did not pass.

The Written Knowledge Test

60 to 90 multiple-choice questions covering nursing assistant theory, patient care, safety, infection control, and professional conduct. Most states offer an oral version for candidates who prefer it. Common topics include patients’ rights, infection control, safe patient handling, mental health and cognitive impairment, and basic restorative services.

The Clinical Skills Demonstration

You perform three to five randomly selected nursing assistant skills in front of a state-approved evaluator. Skills are demonstrated on a mannequin or a fellow exam candidate acting as a simulated patient. The evaluator uses a standardized checklist. You are expected to narrate your steps aloud as you perform them.

Commonly tested skills include hand washing, taking vital signs, providing perineal care, transferring a patient from bed to wheelchair, dressing a patient with a weak arm, and range-of-motion exercises. The skills exam typically takes 25 to 35 minutes.

Two things that matter more than most people expect: hand hygiene and narration. Proper hand washing is evaluated at the start and between each skill. Omitting or rushing it is the single most common reason candidates fail, not because the technique is difficult, but because it feels routine and people move through it on autopilot. Slow down. And narrate everything: “I am washing my hands before providing care to prevent the spread of infection.” The evaluator is checking that you understand the rationale, not just the motion.

Step 6: Get Listed on the Nurse Aide Registry

After passing both parts, your results are submitted to your state’s health department or Board of Nursing, and your name is added to the Nurse Aide Registry. This processing period typically takes 1 to 4 weeks depending on your state’s volume.

Some states allow employers to begin hiring you during this window using your exam pass letter as temporary proof of certification. Check your state’s specific policy if you need to start working before registry processing completes.

Your registry listing shows your name, certification number, certification status (active, expired, or inactive), expiration date, and any substantiated findings of abuse, neglect, or misappropriation. Check your own listing shortly after certification to confirm your name is spelled correctly and your expiration date is accurate. Errors are rare but do occur, and catching them early is much easier than correcting them later.

First 90 Days: What to Do After Certification

Most guides end at “get listed on the registry.” Here is what the first 90 days actually look like, and what to prioritize.

Start applying immediately. Do not wait for your physical card or certificate to arrive. Your registry listing is your credential. Many employers verify status online before scheduling interviews, and your active registry listing is all they need. Begin applying the same week your registry status shows active.

Verify your own registry status. Pull up your state’s online registry lookup and confirm your listing is accurate before you list it on applications. Fix any errors through the registry office before they show up in an employer background check.

Understand what employers will check. Every Medicare- and Medicaid-certified facility is legally required to verify your registry status before placing you in a patient care role. They will look at your certification status, expiration date, and any findings on your record. Your active, clean registry listing is your credential. Keep it that way.

Track your renewal date. Most states require renewal every two years. Renewal requires proof of recent paid CNA employment and in most states 12 hours of in-service education per year. Set a calendar reminder 90 days before your expiration date. Missing renewal is one of the most common and avoidable reasons CNAs lose their certification temporarily.

Consider your next step now. The CNA is the strongest foundation available for a healthcare career. The first 90 days are a good time to decide whether you want to stay in the role long-term, expand your credentials sideways with a PCT or CMA certification, or begin preparing for a nursing bridge program. The CNA Career Path guide covers every direction with real timelines and salary numbers.

Renewal and Reciprocity

Renewal

CNA certification must be renewed on a regular schedule, in most states every two years. Renewal typically requires proof of at least 8 hours of paid CNA employment during the certification period, completion of required in-service education (commonly 12 hours per year), and a renewal application and fee submitted before the expiration date.

If your certification lapses, reinstatement may require additional continuing education, a new background check, or in some cases retaking the competency exam. Keep your contact information updated with your state’s registry. Renewal notices go to the address on file, and missing one is easier than you’d think.

Reciprocity

Moving to a new state means applying for recognition there. Most states have a reciprocity process that allows CNAs certified in good standing elsewhere to apply without retaking the full competency exam. To apply, you typically need an active, unencumbered certification in your current state, a reciprocity application submitted to the new state’s registry, a background check in the new state, and a processing fee. There is no national multi-state CNA compact equivalent to the Nurse Licensure Compact for RNs. Each state processes CNA reciprocity individually. Plan ahead if you are relocating and need to work as a CNA shortly after arriving.

Cost Overview

The total cost of CNA certification varies by state, program type, and whether your employer covers any expenses.

Expense	Typical Cost Range
Training program tuition	$300 to $2,500
Textbooks and supplies	$50 to $200
Background check and fingerprinting	$25 to $100
TB test and immunizations	$20 to $150
CPR certification	$30 to $80
State competency exam fee	$100 to $220
Total estimated range	$500 to $2,500

Under 42 CFR 483.152, any Medicare- or Medicaid-certified facility that hires you within 12 months of completing training is legally required to reimburse your training and exam costs. WIOA grants and Pell Grants at eligible community colleges can also reduce or eliminate these costs. For the full breakdown, see the CNA Training Cost guide.

Resources:

U.S. Bureau of Labor Statistics, Occupational Outlook Handbook: Nursing Assistants;
Centers for Medicare and Medicaid Services (CMS), 42 CFR 483.152;
Omnibus Budget Reconciliation Act of 1987 (OBRA ’87);
National Council of State Boards of Nursing (NCSBN).