Follow the steps to complete the CA DCA BRNPROB113 form online.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Complete the first section with your name and RN number. If not applicable, write 'N/A'.
3. Provide your facility or employer name and the address where you will work, if different from the employer's address.
4. Indicate your proposed start date or the date you began employment at the facility and your job title.
5. Fill in your department or unit area of employment, shift length in hours, and the type of shift (days, evenings, nights).
6. If the position requires on-call duties, check 'Yes' or 'No' and explain if applicable.
7. Describe the orientation process that will ensure your competency to provide safe nursing care.
8. Provide the name, title, email, and phone number of the Department Manager or Supervisor who can discuss your employment position.
9. List the name and title of the highest person in nursing administration or health care and provide their phone number.
10. Propose names and license numbers of individuals who can provide supervision, ensuring they meet the criteria outlined.
11. Initial the acknowledgment section confirming the authorized person's awareness of your probationary status and that they have read the Board’s Decision and Order.
12. Sign and date the form to complete your submission.
13. Once all sections are complete and legible, save changes, download, print, or share the form as needed.

Complete your CA DCA BRNPROB113 form online today for seamless processing!