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Get Ca Cdph 279 2014
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How to fill out the CA CDPH 279 online
The CA CDPH 279 form is essential for individuals applying to become a director of staff development or an instructor in healthcare facilities. This guide will provide clear and detailed steps for completing the form online to ensure a smooth application process.
Follow the steps to complete your application effectively.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Fill in the facility, school, or agency name and address along with the phone number and provider identification training number, which is designated with an 'S' or 'F'.
- Select the type of training you will offer from the available options: Orientation and In-Service Training Programs Only, Nurse Assistant Training Program Only, or Orientation, In-Service, and NATP.
- Enter your name as the applicant, along with your qualifications, indicating whether you are a Registered Nurse (RN) or Licensed Vocational Nurse (LVN).
- Provide your California nursing license number and its expiration date.
- If applicable, write the facility licensed bed capacity, and indicate the date you are submitting the form to the CDPH.
- Sign the application in the designated signature field and indicate your hours worked per week and the date employed as a DSD or instructor.
- Gather and attach the required documents, including your resume detailing relevant work experience, proof of a 24-hour Board of Registered Nursing approved DSD class or related college course transcripts, and a copy of your active nursing license.
- Enter the facility or school information regarding the employer, including the name, telephone number, and mailing address.
- Ensure the administrator and the SNF-DON or NATP RN program director sign the application with their printed names and dates.
- After completing the form and attaching the necessary documents, save your changes, download the file, and print it if needed. You can also share the form with relevant parties as required.
Complete your CA CDPH 279 form online today to take the next step in your application process.
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To obtain CNA reciprocity in California, you must apply through the CA CDPH 279. You will need to provide proof of your current certification and meet specific requirements. It's important to submit an application that includes all required documentation to prevent delays. For a streamlined experience, US Legal Forms can assist with your paperwork and ensure everything is in order.
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