Get Ca Cdph 279 2019-2026

The CA CDPH 279 form is essential for individuals seeking approval as instructors or directors of staff development in California's training programs. This guide provides a clear, step-by-step approach to help users accurately complete the form online.

Follow the steps to effectively fill out the form

1. Press the ‘Get Form’ button to access the document and open it in your preferred online editor.
2. Fill in the facility or school telephone number along with the provider identification training number, which could be an 'F' or 'S' number.
3. Provide the full name and mailing address of the facility or school.
4. Select the types of training you plan to offer by checking the appropriate boxes, such as orientation and in-service training programs or nurse assistant training programs.
5. If applicable, enter your nursing license number as a registered nurse (RN) or licensed vocational nurse (LVN).
6. Complete your personal details, including your full name, mailing address, telephone number, and email address.
7. If you have previously been approved, enter your instructor or DSD number in the designated section.
8. Sign and date the application, indicating your employment hours per week and your employment date as an instructor or DSD.
9. Provide information on the licensed bed capacity of your facility (if applicable).
10. If you are not previously approved as an instructor or DSD, upload the required documentation, including a resume, proof of nursing experience, and course completion certificates.
11. Collect signatures and contact information from the administrator/owner and the director of nursing/program director to confirm the applicant meets the qualifications.
12. Finally, review the completed form before saving your changes, downloading, printing, or sharing the completed document as needed.

Begin filling out your CA CDPH 279 form online today to ensure a smooth application process.