Application Form

Please use this form to submit all relevant information relating to applying.

One file only.
2 MB limit.
Allowed types: gif jpg png bmp eps tif pict psd txt rtf html odf pdf doc docx ppt pptx xls xlsx xml avi mov mp3 ogg wav bz2 dmg gz jar rar sit tar zip.
One file only.
2 MB limit.
Allowed types: gif jpg png bmp eps tif pict psd txt rtf html odf pdf doc docx ppt pptx xls xlsx xml avi mov mp3 ogg wav bz2 dmg gz jar rar sit tar zip.
Do you speak fluent Spanish?
Please indicate if you are able to speak fluent Spanish, and provide care in the Spanish language.
If you are selected to interview, your interview locations will include the Department of State Hospitals (DSH) at Napa State Hospital plus two additional clinics of your choice:
Please select at least two of the following clinics where you would like to interview: