Are you looking for a way to make your business more professional? If so, you may want to consider using the Lic 301E form. This form is used by businesses in order to file their annual reports with the state of Louisiana. By using this form, you can ensure that your business is up-to-date on its licensing and compliance status. Additionally, using the Lic 301E form can help improve your business's image with the state government. If you're interested in learning more about this form or need assistance filing it, please get in touch with our team today.
You can find more details regarding the lic 301e by looking through the table our team compiled for you.
|Form Name||Lic 301E|
|Form Length||2 pages|
|Avg. time to fill out||30 sec|
|Other names||ca reference request, person community 301e download, have 03 lic, community her lic|
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
LIC 301E (7/03)