Lic 9040 Form – Fill Out and Use This PDF

"... Divisional office receipt form for surrender value policy no. on the life of for Rs dated. We hereby declare we have not served any notice to the life insurer corporation of india regarding any of ..."

"... State of California Health and Human Services Agency california Department of Social Services Community Care Licensing Authority Information required by the department social services Community Care License Division applicant name, facility address, local Fire Inspection ..."

"... state of california health and human services agency california department of social services community care licensing division criminal background clearance transfer request active criminal record clearances maybe transferred from one state licensed facility organization to another by license applicant or licensee the transfer request must be submitted to the department before the individual who is the subject of the transfer has client contact or the facility organization will be in violation of the law and subject to 100 civil penalty the license applicant or licensee who is seeking the transfer must provide ali 508 and verify the individuals identity and include copy of the persons drivers license permanent resident card or valid photo identification issued by the california department of motor vehicles or by another state or the united states government if the person is not california resident additionally child abuse central index cac check must be submitted if the transfer is to facility serving children and the individual has not previously submitted cac check or the date of the previous cac inquiry was made prior to january 11999 the cac must be mailed directly to the department of justice with the applicable fee note this transfer request is for clearances only contact your licensing office for information about exemption transfers this form may only be used to request clearance transfer between state licensed facilities organizations to request transfer between county and state licensed facilities the requesting licensing agency must contact their county liaison date please type or print legibly ..."

"... 744 street ms 91447 sacramento ca 95814 date application for administrator recertification certificate effective date expiration date name address city state zip code this letter is to notify you that the administrator certificate issued to you by the california department of social services cds will expire in 90 days in order to maintain compliance with the provisions of the administrator certification program you are required to submit your renewal information and fee prior to the certificate expiration date please submit the following copy of certificates of completion of required continuing education total of 40 forty hours of continuing education is required if you are an administrator for either residential care facility for the elderly an adult residential facility or group home if you area nursing home administrator 20 twenty hours of continuing education are required hours maybe completed through any combination of courses provided by cds approved vendors department of developmental services and approved by the regional center for arf and gh administrators regional center orientations and or challenge tests are not acceptable accredited educational institutions and vendors approved by other california state agencies provided such courses are consistent with the core of knowledge specified in regulations you must submit each course with certificate of completion and description of the courses or it will be returned to you if the course does not relate to the core of knowledge or is dupl cat ive you have taken the identical course before it will not be credited toward the recertification requirement ..."