Get Ca Cdph 502 2012-2026

The CA CDPH 502 form is an essential application for the Administrator-In-Training (AIT) program, overseeing the process of becoming a licensed Nursing Home Administrator in California. This guide provides clear, step-by-step instructions to help you complete the form online with confidence and accuracy.

Follow the steps to effectively fill out the CA CDPH 502 form online.

1. Press the ‘Get Form’ button to access the CA CDPH 502 form and open it in your preferred online editor.
2. Begin by uploading a recent photo of yourself, sized approximately 2" by 2", ensuring that your face is clearly visible for identification purposes.
3. Fill in your name, mailing address, and contact information including your email and telephone numbers.
4. Enter your date of birth and Social Security number in the designated fields. Remember that providing a Social Security number is mandatory for this application.
5. Respond to the questions about your citizenship status, age, and employment history as a Nursing Home Administrator, ensuring that you provide accurate information.
6. If applicable, list any former names and include details about any criminal convictions, ensuring you follow the instructions for additional documentation where required.
7. Outline your educational background, including high school and any relevant degrees, certifications, or diplomas.
8. Provide detailed employment history, beginning with your most recent position, including job titles, responsibilities, and supervisory status.
9. Fill in the preceptor information by providing the preceptor's details and confirming the hours of training and supervision involved in your AIT program.
10. Review all completed sections for accuracy, ensuring all information is true and correct before signing the application.
11. Once finished, save your changes, and download or print your application for submission along with any required documentation.

Start filling out the CA CDPH 502 online today and take the next step towards your nursing home administrator certification!