Get Application For Dsd

This guide provides clear and detailed instructions for completing the Application For Dsd online. Whether you are a trained nurse or an instructor, following these steps will help ensure your application is filled out accurately.

Follow the steps to successfully complete your Application For Dsd.

1. Press the ‘Get Form’ button to access the application and open it in your preferred editor.
2. Enter the facility, school, or agency name and address in the appropriate fields. Ensure that the address is complete and accurate to avoid any communication issues.
3. Provide your contact information, including the facility or agency telephone number.
4. Indicate your provider identification training number, which can be an ‘S’ or ‘F’ number, in the designated field.
5. Select the type of training you will offer by checking the relevant box: Orientation and In-Service Training Programs Only, Nurse Assistant Training Program Only, or Orientation, In-Service, and NATP.
6. Fill in your full name, and specify if you are a Registered Nurse (RN) or Licensed Vocational Nurse (LVN).
7. Enter your California nursing license number along with its expiration date.
8. If applicable, list the facility's licensed bed capacity.
9. Record the date you are submitting the form to the California Department of Public Health (CDPH).
10. Sign where indicated as the applicant, confirming all information is accurate.
11. Indicate your weekly working hours and the start date of your employment as DSD/instructor.
12. Gather the required attachments: a detailed resume with work experience, proof of completion of a 24-hour BRN approved DSD class or relevant college courses, and a copy of your active nursing license.
13. Include the facility or agency employer information, such as their name, telephone number, mailing address, city, county, and zip code.
14. Ensure that the administrator or program director, and the director of nursing sign the appropriate areas on the application.
15. Review the completed application thoroughly for any errors or missing information before finalizing.
16. You can now save the changes, download, print, or share the completed form as needed.

Complete your Application For Dsd online today to ensure a smooth application process.