Forms and documents

LIC 9188 - Criminal Record Exemption Transfer Request

LIC 9188 - Criminal Record Exemption Transfer Request

Form LIC 9188 is used to request the transfer of a criminal record exemption for individuals who have previously been granted an exemption to work or volunteer in care facilities in California.

LIC 9182 - Criminal Background Clearance Transfer Request

LIC 9182 - Criminal Background Clearance Transfer Request

Form LIC 9182 is used to request the transfer of a criminal background clearance for individuals who have previously been cleared for employment or volunteer positions in care facilities in California.

LIC 9165 - Board Of Director Statement

LIC 9165 - Board Of Director Statement

Form LIC 9165 is used by care facilities in California to provide a statement detailing the members of their board of directors. This form includes information such as the names, addresses, and contact details of each board member.

LIC 9163B - Request Live Scan Service - Long Term Care OMBUDSMAN

LIC 9163B - Request Live Scan Service - Long Term Care OMBUDSMAN

Form LIC 9163B is used to request Live Scan services for individuals involved in Long Term Care Ombudsman programs in California. This form is completed by the applicant and submitted to authorized Live Scan service providers, who capture the applicant's fingerprints electronically.

LIC 9163 - Request Live Scan Service - Community Care Licensing

LIC 9163 - Request Live Scan Service - Community Care Licensing

Form LIC 9163 is used to request Live Scan services for individuals seeking employment or volunteer positions in community care licensing programs in California.

LIC 9158 - Telecommunications Device Notification

LIC 9158 - Telecommunications Device Notification

Form LIC 9158 is used by care facilities in California to notify the Department of Social Services about the presence of a telecommunications device within the facility.

LIC 9151 - Property Owner/Landlord Notification Family Child Care Home

LIC 9151 - Property Owner/Landlord Notification Family Child Care Home

Form LIC 9151 is used to notify property owners or landlords about the operation of a family child care home in California.

LIC 200A - Application for a Child Care Center License

LIC 200A - Application for a Child Care Center License

Form LIC 200A is an application form used by individuals or organizations seeking a license to operate a child care center in California.

LIC 200TM - Temporary Manager Application For Provisional License

LIC 200TM - Temporary Manager Application For Provisional License

Form LIC 200TM is a temporary manager application form specifically intended for the provision of a provisional license. It is utilized by individuals applying to serve as temporary managers for community care facilities or residential care facilities for the elderly in California.

LIC 200 - Application For A Community Care Facility or Residential Care Facility For The Elderly License

LIC 200 - Application For A Community Care Facility or Residential Care Facility For The Elderly License

Form LIC 200 is an application form used by individuals or organizations seeking a license to operate a community care facility or residential care facility for the elderly in California.