Get Ca Vacsp (managing Licensee) Supervisor Association/disassociation Application 2016-2025

This guide provides step-by-step instructions for completing the CA VACSP (Managing Licensee) Supervisor Association/Disassociation Application. By following these clear and concise directions, users can efficiently fill out and submit the application online.

Follow the steps to successfully complete your application.

1. Press the ‘Get Form’ button to obtain the application and open it in your chosen editor.
2. Begin by selecting the applicable options for your application from section 1. Choose between Supervisor Association, Supervisor Disassociation, or changing work locations.
3. Provide your VACSP holder information in section 2. Fill in your last name, first name, middle name (if applicable), email address, permit number, and phone number.
4. If you are adding a new supervisor, complete section 3 by entering the supervisor's last name, first name, middle name, license number, premise name, and premise number.
5. For disassociating a supervisor, complete section 4 with the same details as in section 3 but for the supervisor being disassociated.
6. In section 5, fill in the current work location information. This includes the name of the veterinary premise, premise number, physical address, fax number, city, state, and zip code.
7. If applicable, provide information for any new or additional work locations in the same section by repeating the same details.
8. Complete section 6 by certifying your application. Sign and date the certification statement to confirm that the information provided is accurate and complete.
9. Finally, review all sections for accuracy, save your changes, and download or print the completed application for submission.

Complete your CA VACSP application online today for a smooth processing experience.