CDPH 502 Application for AIT Program - California Department of ... 2026

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The document is an application form for the Administrator-in-Training (AIT) program under the California Department of Public Health's Nursing Home Administrator Program. It requires personal information, educational background, work experience, and certification from a preceptor. The form emphasizes the necessity of providing a social security number for identification and compliance with state regulations. Additionally, it outlines the required documentation and responsibilities of both the applicant and preceptor.
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  1. Click ‘Get Form’ to open the CDPH 502 Application in our editor.
  2. Begin by attaching a recent photo of yourself in the designated space. Ensure it is sized approximately 2" by 2".
  3. Fill in your personal information, including your name, mailing address, social security number, and contact details. Make sure all entries are accurate.
  4. Answer the eligibility questions regarding citizenship, age, and employment history. If applicable, provide additional details about previous licenses or certifications.
  5. Complete the education section by listing your educational background and any degrees obtained. Specify if you graduated from high school or possess a GED.
  6. Detail your employment history, starting with your most recent job. Include job titles, responsibilities, and duration of employment.
  7. In the preceptor information section, ensure that all required details about your preceptor are filled out accurately before signing the certification statement at the end.

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CDPH 502

You are applying for the AIT program on the basis of (check only one):. Baccalaureate or higher degree. Ten (10) years of recent full-time work experience, as a

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