Get California Licentiate Supervisor And Operator Permit(s) Application - Cdph Ca

This guide offers a clear and supportive walkthrough for filling out the California Licentiate Supervisor and Operator Permit(s) Application online. Follow these instructions to ensure a successful application process.

Follow the steps to complete your application accurately.

1. Press the ‘Get Form’ button to access the application and open it in the online editor.
2. Begin filling out the form by entering your last name, first name, and middle name as they appear on your legal documents.
3. Provide your date of birth in the required format.
4. Input your social security number. Remember, providing your social security number is mandatory for identification purposes.
5. Enter your phone number and email address to ensure you can be contacted regarding your application.
6. Fill in your mailing address, including city, state, and zip code.
7. Select the appropriate permit category or categories you are applying for, such as Fluoroscopy Supervisor and Operator Permit or Radiography Supervisor and Operator Permit.
8. Prepare the non-refundable application fee of $100 for one permit or $200 for two permits. Ensure the payment is in the form of a check or money order made payable to 'CDPH-RHB.'
9. Include a true and correct copy of your valid California healing arts license as required.
10. After completing the application and gathering necessary documents, mail everything to the California Department of Public Health, Radiologic Health Branch.
11. Keep a copy of your filled application for your records.
12. You may save changes, download, or print the form for your records and future reference.

Start your application online today to ensure you meet all requirements and deadlines.