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Application to restore license to full, active status from inactive, retired or cancelled status to help during the covid-19 pandemic.


Pursuant to the Governor's Executive Order N-39-20, during the State of Emergency, the Director of the California Department of Consumer Affairs may waive any statutory or regulatory requirements with respect to a professional license issued pursuant to Division 2 of the Business and Professions Code (the Code), including the requirements to reactivate or restore a license to active status. Accordingly, the Director temporarily waives any statutory or regulatory requirement that an individual seeking to reactivate or restore a license originally issued pursuant to Division 2 of the Code. Read the full waiver on the DCA Waivers Page.

Select your License Type

Enter your name as it appears on your license

Address of Record:

Phone:

Last 4 Digits of SSN:

Email:

California License Number:

Current status of your license: (check one box only):




You must disclose, if since you cancelled, inactivated or retired your license, you have had any license disciplined by a governmental agency, or have been convicted, or pled guilty, to any crime. Do not list charges dismissed in section 1000.3 of the California Penal Code or equivalent non-California laws, or convictions two years or older under California Health and Safety Code Sections 11357(b), (c), (d), (e), or section 11360(b).

"Conviction" includes a plea of no contest and any conviction that has been set aside or deferred pursuant to Penal Code section 1000 or 1203.4, including infractions, misdemeanor, and felonies.

You do not need to report a conviction for an infraction with a fine of less than $300.00 unless the infraction involved alcohol or controlled substances. You must, however, disclose any conviction which you entered a plea of no contest and any convictions that were subsequently set aside pursuant to Penal Code sections 1000 or 1203.4.

"License" includes permits, registrations, and certificates. "Discipline" includes, but is not limited to, suspension, revocation, voluntary surrender, probation, or any other restrictions.

Since you cancelled, inactivated or retired your license, have you had any license disciplined by a government agency or other disciplinary body, or, have you been convicted of any crime in any state , the U.S.A., and its territories, military court or a foreign country?



To ensure there is sufficient health care professionals available to assist with the COVID-19 outbreak, I certify that I am requesting to activate my license, that would otherwise be considered inactive/retired/cancelled, pursuant to the waiver issued by the Director of the Department of Consumer Affairs and will use my activated status to provide assistance with the COVID-19 pandemic. Further, I will agree to abide by any requirements set forth in DCA - Waiver DCA-20-02.

I CERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALIFORNIA THAT THE INFORMATION I HAVE PROVIDED IN THIS APPLICATION IS TRUE AND CORRECT.