Get Ca Cdph 502 2019-2026

The CA CDPH 502 form is a critical application for those seeking to participate in the Administrator-In-Training (AIT) program managed by the California Department of Public Health. Completing this form accurately is essential for a successful application process.

Follow the steps to complete the CA CDPH 502 online.

1. Press the ‘Get Form’ button to access the CA CDPH 502 form and open it in your chosen editor.
2. Begin by affixing a recent photo of yourself, approximately 2 inches by 2 inches, in the designated area for identification purposes.
3. In the applicant's name section, input your last name, first name, and middle initial.
4. Provide your mailing address, including the street number and name, city, county, state, and zip code.
5. Enter your social security number in the specified field; remember, this disclosure is mandatory for processing your application.
6. Fill out your work telephone number, home telephone number, and optional fax number as needed.
7. Input your date of birth in the format MM/DD/YYYY.
8. Answer the qualifying questions by selecting 'Yes' or 'No' for citizenship status, age, current employment as a nursing home administrator, previous names, criminal history, and existing licenses.
9. For the education section, indicate whether you graduated high school, the highest grade completed if not, and detail any post-secondary education, including degree and dates completed.
10. In the employment history section, chronologically list your job titles, employment dates, facility names, and principal duties, beginning with your most recent job.
11. Document your nursing home work experience, specifying total hours worked, supervisory roles, and relevant details.
12. Complete the preceptor information section, including the preceptor’s name, license number, job title, facility name, and supervisory hours.
13. Review all provided information for accuracy and completeness, ensuring all required signatures are obtained.
14. Once completed, you can save your changes, download or print the form, or share it as appropriate.

Complete your CA CDPH 502 form online today to start your journey in the AIT program.