CNA applicants must submit the following to HWB upon enrollment in the program and before patient contact.
Application: this completed Initial Application (CDPH 283 B); and a copy of the completed Request for Live Scan Services (BCIA 8016) form.
Fingerprint cards: applicants who are unable to obtain electronic prints may complete the fingerprint card (FD-258) and submit two copies to the department.
Initial certificate: issued for two birthdays, not two calendar years, and will expire on your birthday.
Address change: certificate holders shall notify CDPH within sixty (60) days of any change of address.
Name change: if requesting a name change, submit legal verification of the change (marriage certificate, divorce decree, or court documents).
| Question | Answer |
|---|---|
| Form Name | CDPH 283 B |
| Issuing Agency | California Department of Public Health |
| Form Length | 3 pages |
| Who Needs It | Aspiring CNAs and Home Health Aides in California |
| Fillable? | Yes |
| Avg. time to fill out | 10 min |
| Edition | 01/22 |
| Where to send | California Department of Public Health (CDPH) Licensing and Certification Division (L&C) Healthcare Workforce Branch (HWB) MS 3301, P.O. Box 997416 Sacramento, CA 95899-7416 |
| Other names | CDPH 283 B, CDPH 283B, 283B, 283 B, CDPH 283B form, CNA Initial Application |
| Official source | CDPH 283 B (Rev 01/22), California Department of Public Health |
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