Alabama requires only 75 hours of CNA training — the federal minimum and among the lowest training requirements in the United States — making it one of the fastest states to enter the healthcare workforce. The state competency exam is administered by Prometric, and after passing, CNAs are listed on the Alabama DHR Nurse Aide Registry, managed by the Alabama Department of Human Resources rather than the Board of Nursing — a distinction that sets Alabama apart from most other states. The Birmingham metro area, anchored by the University of Alabama at Birmingham (UAB) Health System — one of the largest academic medical centers in the Southeast — drives Alabama's highest CNA wages and career opportunities. Alabama faces a documented severe CNA shortage in rural areas, particularly in the Black Belt counties, creating strong hiring demand for candidates willing to work outside major metros. CNA salaries in Alabama range from $24,000 to $30,000 annually, with hospital positions in Birmingham reaching significantly higher.
Alabama requires exactly 75 hours of CNA training — the federal minimum set by OBRA 1987 — making it one of the most accessible states for CNA certification. Training must include at least 16 hours of classroom/theory instruction and at least 16 hours of supervised clinical practice in a licensed nursing facility. The remaining hours can be split between laboratory training and additional instruction at program discretion. Programs must be approved by the Alabama Department of Public Health (ADPH). Training is available at community colleges, technical colleges, the Red Cross, hospitals, and some long-term care facilities offering employer-sponsored programs.
Alabama uses Prometric to administer the state CNA competency exam. The written section contains 70 multiple-choice questions with a 90-minute time limit. The clinical skills evaluation requires demonstrating 5 randomly selected skills from the approved Alabama skills list. Candidates must pass both sections within 24 months of completing their approved training program, with up to 3 total attempts. An oral version of the written test is available for candidates with documented reading difficulties. Prometric testing sites in Alabama are located in Birmingham, Montgomery, Huntsville, and Mobile.
Alabama requires a criminal background check for CNA candidates seeking employment in Medicaid/Medicare-certified facilities. The check is processed through the Alabama Bureau of Investigation (ABI) and includes state and federal criminal history. The Alabama DHR Nurse Aide Registry maintains records of any substantiated findings of abuse, neglect, or misappropriation of property. Any CNA with such a finding on the registry is barred from working in any federally certified long-term care facility in Alabama. Employers are required to verify DHR registry status before hiring.
Before beginning clinical rotations at an Alabama nursing facility, CNA students must provide proof of a negative TB test (Mantoux PPD or QuantiFERON Gold) within the past 12 months, a physician's physical clearance form, and current CPR/BLS certification. Most approved programs also require current immunizations including the Hepatitis B series, MMR, Varicella, Tdap, and seasonal influenza vaccine. Individual training programs may have additional requirements beyond the ADPH minimum. These documents must typically be submitted before the first clinical day.
Birmingham and the metro area — including Jefferson, Shelby, Blount, St. Clair, and Walker counties — is Alabama's dominant CNA market. The University of Alabama at Birmingham (UAB) Health System is the state's largest employer of CNAs and one of the top academic medical centers in the Southeast, offering competitive wages, tuition reimbursement, and clear career ladders. UAB Hospital, Children's of Alabama, and Grandview Medical Center are all major CNA employers in the city. Ascension St. Vincent's Health System operates four hospitals in the Birmingham metro and actively recruits CNAs with employer-sponsored training. Jefferson State Community College and Lawson State Community College both offer state-approved CNA programs at community college tuition rates (approximately $500–$1,200 for Alabama residents). American Red Cross Birmingham chapter also runs periodic CNA training cohorts. Hospital CNAs in Birmingham average $14–$18/hour; SNF and home health positions average $12–$15/hour. CNA scholarships and workforce development grants through Alabama Career Centers (AlabamAworks!) are available for eligible candidates throughout the metro.
Montgomery, Alabama's capital, is the state's second-largest CNA market, centered around Baptist Health Montgomery (a major not-for-profit system with two campuses), Jackson Hospital, and the Veterans Affairs Central Alabama Health Care System at the Montgomery VA Medical Center. State government employment also drives demand for CNAs in assisted living and memory care facilities serving the capital region. Trenholm State Community College (Montgomery campus) offers an accredited CNA program that is among the most affordable in the state. Alabama Christian Academy and several private health training centers in Montgomery also offer quick-start CNA programs. Montgomery CNAs earn an average of $12–$15/hour, reflecting the city's lower cost of living compared to Birmingham. The Prattville and Millbrook suburbs have seen growing healthcare development as Montgomery's population expands. CNA registry verification for Montgomery-area candidates goes through the Alabama DHR online portal. Many Montgomery healthcare employers offer direct-hire bonuses for CNAs who commit to 12+ months of employment.
Huntsville, Alabama's fastest-growing city, represents the state's most dynamic emerging CNA market. The healthcare sector is expanding rapidly alongside Huntsville's aerospace and defense industry boom. Huntsville Hospital (the flagship of Huntsville Hospital Health System — one of Alabama's largest healthcare networks with 8 hospitals) is the primary CNA employer and frequently posts for CNAs across its acute care, long-term care, and rehabilitation divisions. Crestwood Medical Center and Madison Hospital are additional major Huntsville metro employers. Calhoun Community College (Huntsville and Decatur campuses) offers state-approved CNA training, and Drake State Community and Technical College provides affordable allied health programs in the area. Huntsville CNAs earn $13–$17/hour — higher than Montgomery but below Birmingham hospital rates. The growing Redstone Arsenal military community creates strong demand for VA-affiliated and TRICARE-eligible CNA positions. North Alabama's senior population is growing rapidly, and free CNA classes may be available through AlabamAworks! workforce centers in Huntsville.
Mobile, Alabama's only Gulf Coast city, has a distinct healthcare market shaped by its port economy, Mardi Gras culture, and proximity to the Mississippi Gulf Coast and Pensacola, Florida. Mobile Infirmary Medical Center and USA Health University Hospital (operated by the University of South Alabama — a major academic medical institution) are the primary acute care CNA employers in Mobile. Infirmary Long Term Care operates multiple SNFs in the Mobile area and is among the largest CNA employers outside of hospital settings. Bishop State Community College offers an accredited CNA program in Mobile at community college rates. The coastal counties of Baldwin and Mobile have seen strong retirement community growth, creating sustained demand for home health and ALF CNAs throughout the region. Mobile CNAs earn an average of $12–$15/hour. The proximity to Pensacola and Biloxi means Alabama-certified CNAs working in Mobile can sometimes secure higher-paying reciprocity transfers to Florida or Mississippi if wages are significantly better in the neighboring market.
Tuscaloosa, home to the University of Alabama, has a mid-sized but growing healthcare market anchored by DCH Regional Medical Center (part of DCH Health System) and UAB West — a partnership facility between the city and UAB Health System. Shelton State Community College in Tuscaloosa offers an affordable state-approved CNA program. The rural Black Belt counties of Alabama — including Wilcox, Perry, Hale, Greene, and Sumter — face the state's most severe CNA shortage. These counties have aging populations, high poverty rates, and extreme provider shortages, with some counties having fewer than 5 CNAs per 1,000 elderly residents. Rural CNAs in these areas often earn less ($11–$13/hour) but face minimal competition for positions and may qualify for HRSA Rural Health grants or state loan forgiveness programs. The Alabama Rural Health Association actively advocates for CNA pipeline development in these counties. For CNAs considering rural practice, working as a CNA in rural Alabama often means a broader scope of patient contact, faster advancement to charge/lead roles, and high community impact.
Search the Alabama Department of Public Health (ADPH) website for a list of approved nurse aide training programs. Options include community colleges, technical colleges (ACCS system), Red Cross chapters, hospital-based programs, and some long-term care facilities offering employer-based training. With only 75 hours required, many programs complete in 2–3 weeks full-time.
Obtain your TB test, physical examination clearance, current immunizations, and CPR/BLS certification. Submit to a criminal background check through the Alabama Bureau of Investigation (ABI). Gather required documentation: valid photo ID, Social Security card, and health clearance forms. Some programs require these before starting any coursework.
Attend your Alabama-approved CNA program: at least 16 hours of classroom instruction, at least 16 hours of supervised clinical practice at a licensed Alabama nursing facility, and remaining hours in laboratory training and combined instruction. Full-time programs can complete in 2–3 weeks; part-time programs typically take 4–6 weeks. Alabama's 75-hour minimum is among the shortest in the country.
After program completion, register for both the written and clinical skills exams through Prometric (prometric.com). You'll need your program completion certificate and valid photo ID. Testing sites are located in Birmingham, Montgomery, Huntsville, and Mobile. Schedule both sections — some candidates can take them on the same day.
Take the written knowledge test (70 questions, 90 minutes, 70% to pass) and the clinical skills evaluation (5 randomly selected skills from the Alabama approved list — all must be passed). Both sections must be passed within 24 months of completing training. You have up to 3 attempts. An oral option is available if needed.
After passing both exam sections, Prometric reports results to the Alabama DHR, which manages the Nurse Aide Registry. You will receive notification and your registry listing. The process typically takes 2–4 weeks after exam passage. Your registry status can be verified by employers through the Alabama DHR website.
Apply to UAB Health System, Baptist Health, Huntsville Hospital, or long-term care facilities statewide. Alabama law allows CNA candidates to begin working in a training capacity while awaiting registry placement, subject to employer policy. Birmingham and Huntsville offer the highest wages; rural areas offer the fastest hiring and strongest job security due to documented shortages.
Alabama is one of only a handful of states where the Certified Nursing Assistant registry is managed by the Department of Human Resources (DHR) rather than the Board of Nursing or a Department of Health. This administrative distinction has significant practical implications for CNA candidates, employers, and out-of-state applicants seeking reciprocity.
Why DHR and Not the Board of Nursing? Alabama's nurse aide regulatory framework was established under the state's human services infrastructure rather than its professional licensing system. The Alabama DHR Nurse Aide Registry (accessible at dhr.alabama.gov) maintains the official list of certified nurse aides in good standing, including any findings of abuse, neglect, or misappropriation. Because this is a DHR function — not a healthcare licensing function — the registry operates somewhat differently from states where the Board of Nursing controls CNA records. Reciprocity applications, registry verifications, and status inquiries all go through DHR, not through the Alabama Board of Nursing.
What the Alabama DHR Registry Contains: The registry lists every Alabama-certified CNA, including their certification status (active/inactive/expired), the date of initial certification, the date of most recent renewal, and any substantiated findings of abuse, neglect, or misappropriation of resident property. Any individual with a substantiated finding is permanently barred from employment in any Medicaid/Medicare-certified long-term care facility in Alabama. Employers are legally required to check the DHR registry before hiring any CNA.
Reciprocity Through Alabama DHR: CNAs certified in other states must apply for reciprocity directly through the Alabama DHR — not through a nursing board — by submitting verification of their current registry status, a completed Alabama reciprocity application, and passing an Alabama criminal background check. Most states with valid active CNA certifications and clean registry records can transfer without retesting. Processing takes 4–8 weeks. See our CNA reciprocity guide for a full multi-state comparison. If your out-of-state certification has lapsed (more than 24 months of no paid nursing employment), you will likely need to retake the full Prometric competency exam.