[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-306477-105":53,"doc-detail-306477-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","certified-nurse-assistant-cna-equivalencyreciprocity-application","CERTIFIED NURSE ASSISTANT (CNA) EQUIVALENCY/RECIPROCITY APPLICATION","","Application form for Certified Nurse Assistant (CNA) equivalency or reciprocity through the California Department of Public Health (CDPH) Licensing and Certification Division. Collects applicant identity and contact details, request type (equivalent training or reciprocity from another state), and required background disclosures including criminal convictions and adverse licensing actions. For equivalency, requests training details such as completion of Fundamentals of Nursing and passing scores, plus employer or school information. For reciprocity, requests prior certificate and work history, followed by applicant certification, signature, and date.",{"@graph":63,"@context":123},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":41,"@type":70,"position":76},"https://docshare.wps.com/template/letters/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/certified-nurse-assistant-cna-equivalencyreciprocity-application/306477/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/certified-nurse-assistant-cna-equivalencyreciprocity-application/306477.png","ImageObject",442,249,{"name":88,"@type":89},"Putri","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-14","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",13,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115,119],{"name":106,"@type":107,"acceptedAnswer":108},"What are the two main request types on this CNA application?","Question",{"text":109,"@type":110},"Applicants select either equivalency based on equivalent training (complete sections I, II, III, IV and VI) or reciprocity from another state (complete sections I, II, III, V and VI).","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"What background questions must be answered in Section III?",{"text":114,"@type":110},"Section III asks whether the applicant has been convicted of any crime (other than a minor traffic violation) and whether any health-related licensing/certification/disciplinary authority has taken adverse action against them.",{"name":116,"@type":107,"acceptedAnswer":117},"What additional documents are required for equivalency-trained nurse assistant applicants?",{"text":118,"@type":110},"The form requests a completed initial application (CDPH 283 B), an official sealed transcript or an approved sealed letter describing equivalent training and Fundamentals of Nursing completion, proof of work in the last two years (with listed exceptions), and a copy of the completed Request for Live Scan Services (BCIA 8016).",{"name":120,"@type":107,"acceptedAnswer":121},"What information is required for reciprocity applicants in Section V?",{"text":122,"@type":110},"Section V requests the transferring state, certificate issue and expiration dates, employer information (if applicable), the CNA certificate number, and last date worked (if applicable).","https://schema.org",{"og:url":78,"og:type":125,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":127,"canonical":78},"index,follow",{"doc_id":129,"site_id":56},306477,1791393346,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":88,"user_avatar":134,"doc_module":9,"category_id":40,"category_name":41,"doc_title":59,"doc_description":61,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":79,"language":140,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":61,"update_tm":144,"read_time":73},962085571259,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","State of California-Health and Human Services Agency MAIL OR FAX APPLICATION TO:  \nCalifornia Department of Public Health (CDPH) Licensing and Certification Division (L&C) Healthcare Workforce Branch (HWB)  \nMS 3301, P.O. Box 997416  \nSacramento, CA 95899-7416  \nPHONE: (916) 327-2445 FAX: (916) 552-8785  \nCERTIFIED NURSE ASSISTANT (CNA) EQUIVALENCY/RECIPROCITY APPLICATION  \n(See instructions on the reverse)  \nSECTION I (REQUIRED)  \nTYPE OF REQUEST  \n Check here if you have EQUIVALENT TRAINING (complete sections I, II, III, IV and VI)  \n Check here if you are requesting RECIPROCITY FROM ANOTHER STATE (complete sections I, II, III, V and VI)  \n\n| SECTION II (REQUIRED) |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- |\n| Last Name |  | First Name |  |  |  | MI | Sex\u003Cbr> Male  Female |\n| Public Address (Required)–Subject to Public Records Act Request release* |  |  | City |  |  | State | Zip Code |\n| Confidential Address (Required) - (For CDPH Use only. If left blank all departmental mail will be sent to the address above) |  |  | City |  |  | State | Zip Code |\n| Date of Birth\u003Cbr>(mm/dd/yy) | Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN)\u003Cbr>- -\u003Cbr>**If you use an invalid SSN, your application process may be delayed |  |  |  | Driver’s License or State ID Number Number  \u003Cbr>State   |  |  |\n| Phone Number ***\u003Cbr>☐ By checking this box, you agree to receive text messages from the California Department of Public Health (CDPH) for reminders and notifications regarding your application and/or certification. You may receive up to 5 messages per year. Message and data rates may apply. By checking this box, you agree to the Terms and Conditions and Privacy Policy.\u003Cbr>Reply “STOP” to opt-out, and “HELP” for help. |  |  |  | Email Address*** |  |  |  |\n\nCDPH 283E (05/22) This form is available on [our website at:](our website at: www.cdph.ca.gov)[ ](our website at: www.cdph.ca.gov)[www.cdph.ca.gov](our website at: www.cdph.ca.gov) Page 1 of 4  \nSECTION III (REQUIRED)  \n1) Have you been CONVICTED , at any time, of any crime, other than a minor traffic violation? (You need not disclose any marijuana-related offenses specified in the marijuana reform legislation and codified at the Health and Safety Code, Sections 11361.5 and 11361. 7) .  \n☐ Yes ☐ No  \n- If yes, list conviction:    \n- Court of conviction:   Date:    \n2) Has any health-related licensing, certification or disciplinary authority taken adverse action (revoked, annulled, cancelled, suspended, etc.) against you?  \n☐ Yes ☐ No  \n- Type of License/Certificate:    \n- License/Certificate Number:    \n- Type of Action:    \nSECTION IV EQUIVALENCY APPLICANTS (* are required fields)  \n\n| *Type of Equivalent training received:\u003Cbr>__________________________\u003Cbr>* Date Fundamentals of Nursing completed:    (mm/dd/yy)\u003Cbr>Name of Employer (if applicable):\u003Cbr>Last Date worked (if applicable):\u003Cbr>_____________________________ | * Name of School/Military Branch:\u003Cbr>* Did you obtain a passing score for Fundamentals of Nursing?\u003Cbr> Yes  No |\n| --- | --- |\n\n\n| SECTION V RECIPROCITY APPLICANTS (* are required fields) |  |  |\n| --- | --- | --- |\n| *State transferring from:\u003Cbr>*Certificate Issue Date: Name of Employer: | * CNA Certificate Number: |  |\n|  | *CNA Certificate Expiration Date: |  |\n|  | Last date worked (if applicable): |  |\n| SECTION VI (REQUIRED) |  |  |\n\nI certify under penalty and perjury under the applicable state and federal laws that the information contained in this application and supporting documents, is true and correct. I further understand that any false, incomplete, or incorrect statements may result in denial of this application. I acknowledge that signing this document through electronic means shall have the same legal validity and enforceability as a manually executed signature or use of a paper-based record keeping system to the fullest extent permitted by applicable law.  \nSignature of Applicant Date  \nCDPH 283E (05/22)","cbCaif4yLV7FfNz7","https://ap.wps.com/l/cbCaif4yLV7FfNz7","pdf",384445,"English","# SECTION I (REQUIRED)\n## TYPE OF REQUEST\n# SECTION II (REQUIRED)\n## Applicant identity and contact information\n# SECTION III (REQUIRED)\n## Convictions and adverse licensing actions\n# SECTION IV EQUIVALENCY APPLICANTS\n## Equivalent training details\n# SECTION V RECIPROCITY APPLICANTS\n## Prior state/certificate details\n# SECTION VI (REQUIRED)\n## Applicant certification, signature, and date","[{\"question\":\"What are the two main request types on this CNA application?\",\"answer\":\"Applicants select either equivalency based on equivalent training (complete sections I, II, III, IV and VI) or reciprocity from another state (complete sections I, II, III, V and VI).\"},{\"question\":\"What background questions must be answered in Section III?\",\"answer\":\"Section III asks whether the applicant has been convicted of any crime (other than a minor traffic violation) and whether any health-related licensing/certification/disciplinary authority has taken adverse action against them.\"},{\"question\":\"What additional documents are required for equivalency-trained nurse assistant applicants?\",\"answer\":\"The form requests a completed initial application (CDPH 283 B), an official sealed transcript or an approved sealed letter describing equivalent training and Fundamentals of Nursing completion, proof of work in the last two years (with listed exceptions), and a copy of the completed Request for Live Scan Services (BCIA 8016).\"},{\"question\":\"What information is required for reciprocity applicants in Section V?\",\"answer\":\"Section V requests the transferring state, certificate issue and expiration dates, employer information (if applicable), the CNA certificate number, and last date worked (if applicable).\"}]","CERTIFIED NURSE ASSISTANT (CNA) EQUIVALENCY/RECIPROCITY APPLICATION | PDF",1789836998]