Lic 301E PDF Details

When it comes to ensuring the safety and quality of community care facilities in California, the LIC 301E form plays a crucial role. This form, crafted by the California Department of Social Services' Community Care Licensing Division, is a vital step for anyone applying to operate, work, or live in a variety of community care settings. It requires applicants to secure a reference who can vouch for their character and suitability for working with vulnerable client groups, such as children, the elderly, or individuals with disabilities. The form mandates that the reference, who cannot be a relative, client, or current staff member of the facility, provide honest feedback on the applicant's character, interactions with potential client groups, and overall aptitude for working in such an important and sensitive environment. Completing the LIC 301E form thoroughly and thoughtfully is essential, as it helps the licensing body ascertain the applicant's ability to provide high-quality, compassionate care to those in need.

QuestionAnswer
Form NameLic 301E
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesname 301e form, your 03 lic form, ca lic 301e, lic 301e

Form Preview Example

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

 

COMMUNITY CARE LICENSING

REFERENCE REQUEST FOR: _____________________________________

To operate or work in facility type:

You must enter your full name and facility type before you give this form to your reference for completion.

The above named person has applied to operate, work or reside in a community care facility serving the client group indicated above. This person has selected you to write a reference statement on his/her behalf. If you work at the facility, are a client of the facility, or are related to this person in any way, you may not complete this reference statement.

Please complete the entire form. Your honest reply will help us ensure high quality care in our licensed facilities. Your Name: _______________________________________________________________________

Street Address: ____________________________________________________________________

City _____________________________ State _________________ Zip ________________

Day Time Telephone Number: (_____) _______________________

1. How long have you known the person you are writing this reference for?

2. How do you know this person?

LIC 301E (7/03)

REFERENCE REQUEST FOR:

3. Please give your opinion of this person’s character.

4.Please describe any interaction you have observed between this person and the client group he/she is requesting to work with. For example: Clients may be children, developmentally disabled children or adults, mentally impaired adults, or elderly.

5.Please add any comments you feel are relevant about this person and his/her desire to work in a community care facility.

PRINT YOUR NAME

YOUR SIGNATURE

DATE

LIC 301E (7/03)

How to Edit Lic 301E Online for Free

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Step 2: Once you've entered the person community 301e download edit page, you'll discover all functions you can use regarding your document within the upper menu.

For every single part, complete the information required by the platform.

reference how lic make spaces to complete

Remember to enter your particulars within the area Day Time Telephone Number, How long have you known the, and How do you know this person.

Entering details in reference how lic make part 2

The application will request for additional info with the intention to quickly complete the field LIC E.

Finishing reference how lic make part 3

The REFERENCE REQUEST FOR, Please give your opinion of this, Please describe any interaction, and requesting to work with For section has to be applied to provide the rights or obligations of both parties.

stage 4 to finishing reference how lic make

Look at the fields Please add any comments you feel and next fill them in.

reference how lic make Please add any comments you feel fields to fill out

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