In the complex landscape of licensing and child protection, the State of California has established stringent measures to ensure the safety and well-being of children under the care of various facilities. The LIC 198 form plays a pivotal role in this ecosystem, serving as a crucial step for individuals and entities looking to operate child day care or residential facilities. Mandated by the California Department of Social Services, this form is a gateway to a comprehensive Child Abuse Central Index Check, a process that underscores the commitment towards safeguarding children from potential abuse. Applicants are tasked with providing detailed personal information, including their name, address, physical attributes, and social security number, along with a requisite fee of $15.00 for the processing of the check. It's a procedural measure that draws a clear line of accountability, ensuring that individuals with a history that may compromise the safety of children are meticulously screened out. Moreover, the form emphasizes the collaboration between county licensing offices and the Department of Justice, illustrating a multi-layered approach to child safety that underscores both prevention and due diligence. Through this nuanced process, the LIC 198 form embodies a critical filter in the licensing mechanism, weaving a tighter safety net for California’s most vulnerable citizens.
| Question | Answer |
|---|---|
| Form Name | Form Lic 198 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | submitting, recheck, lic 198, exemption |
STATE OF |
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES |
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COMMUNITY CARE LICENSING |
CHILD ABUSE CENTRAL INDEX CHECK FOR COUNTY LICENSED FACILITIES
FOR COUNTY LICENSING OFFICE USE ONLY
COUNTY LICENSING OFFICE ADDRESS STAMP
NOTE: APPLICANT/LICENSEE MUST NOT SEND THIS FORM DIRECTLY TO DEPARTMENT OF JUSTICE
(This form is to be processed through your county licensing office)
Complete ALL items checked (✔)
Include $15.00 for each Child Abuse Central Index Check. (There is no exemption from this fee) Make check or money order payable to the Department of Justice.
We are required by law to check the names of all persons who apply for a license or seek employment in a child day care or residential facility caring for children against the Child Abuse Central Index. Persons required to submit fingerprints for a child care facility (day or residential) must also fill out this form. Please complete the information below. The Licensee is responsible for submitting fingerprints and this form along with the Child Abuse Central Index Check processing fee to the county licensing office.
TYPE OR PRINT INFORMATION |
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✔ |
DATE SENT________________ |
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NAME: |
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LAST |
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FIRST |
MIDDLE |
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List all other names you have ever used such as maiden name or aliases: |
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NAME: |
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NAME: |
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NAME: |
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NAME |
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CURRENT ADDRESS |
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STREET |
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CITY |
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STATE |
ZIP CODE |
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✔ |
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HEIGHT ✔ |
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WEIGHT ✔ |
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HAIR COLOR ✔ |
EYE COLOR ✔ |
DRIVER'S LICENSE NUMBER ✔ |
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■ MALE |
■ FEMALE |
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DATE OF BIRTH ✔ |
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SOCIAL SECURITY NUMBER ✔ |
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MO. DAY |
YEAR |
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✔ FACILITY NUMBER: |
________________________________________________________________________________________ |
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✔ FACILITY NAME: |
________________________________________________________________________________________ |
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✔ FACILITY ADDRESS: |
________________________________________________________________________________________ |
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STREET |
CITY |
STATE |
ZIP CODE |
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FOR LICENSING OFFICE USE ONLY |
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DO NOT FILL IN BELOW |
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Date Sent __________________ |
Date |
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■This is a recheck. See attached Criminal Record Report
FOR DEPARTMENT OF JUSTICE USE ONLY
The result of a name search in the Child Abuse Central Index is as follows:
■The subject of the attached report MAY be the same as the subject of your inquiry.
■
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No record on the above listed person.
Too many possible matches to identify. See attached listing.
LIC 198 (2/01)