
Attachment ASacramento County Department of Health Services Division of Behavioral Health Services QUALITY MANAGEMENT STAFF REGISTRATION APPLICATIONAvatar Staff ID Number (if known): New: Agency Agency.
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How to fill out the CA Staff Registration Form - Sacramento County online
This guide provides a clear and thorough explanation of how to complete the CA Staff Registration Form for Sacramento County online. It covers each section of the form in detail, ensuring that users can easily navigate the process with confidence.
Follow the steps to fill out the CA Staff Registration Form online.
- Select the ‘Get Form’ button to access the CA Staff Registration Form. This will allow you to obtain the form and open it in your preferred editing application.
- Begin by entering the Avatar Staff ID number if you have one. If not, leave this field blank and proceed.
- Indicate whether you are completing the form for a new registration or an update by checking the appropriate box.
- Fill in the agency details in the Agency section, including the agency name, phone number, contact person, and contact email.
- In the Applicant section, provide the applicant's name, date of birth, and social security number. Also, include any previous names or aliases.
- Select the gender and any secondary language spoken by the applicant.
- Document the date of employment and employment status by choosing the appropriate designation between full-time, part-time, contracted, temporary/on-call, volunteer, or other.
- Specify the start date in classification and provide details on mental health classification. Choose one from the list provided and attach relevant licenses or certifications.
- Include the registration/license number and expiration date where applicable.
- If applicable, include information on dual ADS/mental health role classification and whether co-signature is always required.
- Complete the staff termination section if necessary, including the date of termination.
- Finally, review all the information entered for accuracy. Save any changes to the document, and download or print the completed form if required. You can also share the form using email or fax, as indicated.
Complete your CA Staff Registration Form online today for a seamless process.
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