Follow the steps to complete the CA CDPH 283 B form online.

1. Press the ‘Get Form’ button to access the form and open it in your online editor.
2. Begin by completing Section I, where you will indicate your type of request. Choose from one of the options: enrolling in a CNA training program, enrolling in an HHA training program, equivalent training, or requesting reciprocity from another state.
3. Move to Section II, which requires personal information. Fill in your last name, first name, middle initial, sex, mailing address, city, state, zip code, date of birth, social security number, driver’s license or state ID number, telephone number, height, weight, hair color, and eye color.
4. In Section III, answer whether you have been convicted of any crime other than a minor traffic violation. If yes, provide details regarding the conviction and the court of conviction. Additionally, indicate if any health-related licensing or certification authority has taken adverse action against you.
5. If applicable, complete Section IV by providing the name of the school or facility where you received or will receive your CNA or HHA training, along with the mailing address, telephone number, California Training Program ID number, and training dates.
6. In Section V, certify your application by signing and dating the form.
7. Finally, review all sections to ensure accuracy. Save your completed form, download it for your records, print it if necessary, or share it as required.

Complete your CA CDPH 283 B application online today for a seamless application experience.