Form Lic 38 – Fill Out and Use

"... State of California Health and Human Services Agency. California Department of Social Services Community Care Licensing Division. Information for applicants. This form is for all persons applying for facility licensure. Please provide references, including past ..."

"... Assignments during an emergency: reverse side ..."

"... state of california health and human services agency california department of social services request for lives can service community care licensing applicant submission ori 04482 working title check one adult resident other than client employee license certification applicant volunteer home care aide registry applicant authorized applicant type enter from list on page doj abbreviated ccl facility organization type agency address set contributing agency adept of social services 03502 agency authorized to receive criminal history information mail code five digit code assigned by doj po box 94244 mail station 91562 na street no street or po box contact name mandatory for all school submissions sacramento ca 942442430 na city state zip code contact telephone no applicant information name of applicant please print last first iaka scd no last first dob sex male female misc no bil agency billing number if applicable ht wt misc no permanent resident 551 out of state drivers license or id eye color hair color home address all applicants must complete po street or po box soc see privacy statement on page city state and zip code facility organization number level of service doj fbi if re submission for fingerprint quality select list origin latino employer additional response for department of social services mv chp licensing and department of corporations submissions only employer name street no street or po box mail code five digit code assigned by doj city state zip code agency telephone no optional lives can transaction completed by date name of operator transmitting agency ..."

"... California department of Social Services Community Care Licensing Division Child Care Center Notification of Parents Rights Parent Authorized Representatives have the right to inspect child-care centers without prior notice. If you present a certified copy ..."