Personnel Record PDF Details

Handling the process of onboarding new employees or updating existing staff records necessitates a comprehensive approach to gathering essential information, a task facilitated significantly by the use of the Personnel Record form. This document, as utilized by the State of California Health and Human Services Agency, specifically within the California Department of Social Services, functions as a cornerstone for recording vital data pertaining to employees. It meticulously covers personal details starting from the employee’s name, contact information, age verification, and social security number—for identification purposes—to more specific inquiries such as the possession of a valid California Driver's License and the status of its suspension or revocation. Furthermore, it extends to capturing employment critical information, including the position title, salary, and supervisor's name, alongside a succinct history of previous employment. The form also delves into educational background, highlighting the highest level of education completed, and any employment-related courses taken, a section which importantly aids in understanding the qualifications of the employee. It continues to detail professional and technical qualifications through listing relevant licenses or certificates held and membership in professional associations, eventually culminating with a section for references that can vouch for the employee’s background, character, and abilities. Not only does this record provide a comprehensive snapshot of an employee’s qualifications and history, but it also stands as a legal document, with the employee’s signature certifying the truthfulness of the information under penalty of perjury, thereby underscoring the seriousness and importance of accurate and honest disclosure.

QuestionAnswer
Form NamePersonnel Record
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other nameslic 501 personnel record, lic 501 form, lic 501 community care licensing, lic 502 form

Form Preview Example

STATE OF CALIFORNIA—HEALTH AND HUMAN SERVICES AGENCY

PERSONNEL RECORD

(Form to be completed by employee)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

DATE

NAME OF FACILITY

FACILITY ADDRESS

FACILITY FILE NUMBER

1.PERSONAL

NAME (LAST

FIRST

MIDDLE)

TELEPHONE

 

 

 

 

 

 

 

(

)

 

 

ADDRESS

 

 

 

 

 

 

ARE YOU 18 YEARS OF AGE OR OLDER?

 

 

 

 

 

 

 

■ YES

■ NO

IF NO, PLEASE STATE YOUR AGE

 

 

 

 

 

 

 

 

 

_____________________________

 

 

 

 

 

 

 

SOCIAL SECURITY NUMBER: (VOLUNTARY FOR ID ONLY)

 

DATE OF LAST PHYSICAL EXAMINATION

 

DATE OF LAST TB TEST

-

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HAVE YOU EVER BEEN EMPLOYED UNDER A DIFFERENT NAME? ■ YES ■ NO

IF YES, PLEASE LIST ALL NAMES USED.

 

 

 

 

 

 

 

 

 

 

 

DO YOU POSSESS A VALID CALIFORNIA DRIVER'S LICENSE?

■ YES ■ NO

 

 

HAS YOUR DRIVER'S LICENSE EVER BEEN SUSPENDED OR REVOKED? ■ YES ■ NO

CDL NUMBER

 

 

 

 

 

IF YES, PLEASE EXPLAIN ON BACK OF FORM.

 

 

 

NEAREST LIVING RELATIVE — NAME:

 

 

 

 

 

 

TELEPHONE NUMBER

 

 

RELATIONSHIP

 

 

 

 

 

 

 

 

 

 

 

ADDRESS

2.POSITION

TITLE

SALARY

HOURS

DATE OF EMPLOYMENT

NAME OF SUPERVISOR

3.PREVIOUS EMPLOYMENT (List most recent experience first. If additional space is needed, please attach a separate page.)

NAME AND ADDRESS OF EMPLOYER

TELEPHONE

NUMBER

JOB TITLE AND TYPE OF WORK

REASON FOR

LEAVING

DATES

FROM TO

4.EDUCATION

CIRCLE HIGHEST YEAR COMPLETED

6

7

8

9

10

11

12

DIPLOMA

CURRENTLY ENROLLED IN HIGH SCHOOL COMPLETION COURSE?

■ NO

■ YES IF YES, GIVE EXPECTED COMPLETION DATE___________________

EMPLOYMENT — RELATED EDUCATION COURSES

COURSE TITLE

NAME OF SCHOOL OR ORGANIZATION

AND ADDRESS

NUMBERDATE CURRENTLY UNITS

COMPLETED COMPLETED ENROLLED

LIC 501 (3/99)

(OVER)

4.EDUCATION (CONTINUED)

NAME UNIVERSITY, COLLEGE OR BUSINESS SCHOOL

AND ADDRESS

MAJOR

SUBJECT

NO. OF

NO. OF

DIPLOMA

 

YEARS

UNITS

DEGREE OR

DATE

COMPLETED

COMPLETED

CERTIFICATE

COMPLETED

 

 

 

 

5. REFERENCES

List names of three persons who can give information about your background, character, abilities, etc.

NAME

ADDRESS

TELEPHONE

NUMBER

RELATIONSHIP TO YOU

(FRIEND, EMPLOYER, ETC.)

6.PROFESSIONAL AND TECHNICAL QUALIFICATIONS

A.List Licenses or Certificates of Competence held:

B.Names of Professional Associations of which you are a member:

NOTES:

I hereby certify under penalty of perjury that the above statements are true and correct. I give my permission for any necessary verification.

SIGNATURE OF EMPLOYEE

DATE

How to Edit Personnel Record Online for Free

The whole process of filling out the lic 501 form california printable is actually comparatively effortless. We ensured our editor is not difficult to utilize and helps prepare just about any PDF within minutes. Take a look at a few simple steps you will need to take:

Step 1: Find the button "Get Form Here" on the site and select it.

Step 2: At the moment you're on the file editing page. You can modify and add information to the document, highlight words and phrases, cross or check certain words, include images, insert a signature on it, erase unrequired areas, or remove them altogether.

Complete the particular areas to fill out the document:

step 1 to writing lic personal record

Type in the expected particulars in the box CDL NUMBER NEAREST LIVING RELATIVE, TELEPHONE NUMBER, RELATIONSHIP, ADDRESS, TITLE, NAME OF SUPERVISOR, POSITION SALARY, HOURS, DATE OF EMPLOYMENT, PREVIOUS EMPLOYMENT List most, NAME AND ADDRESS OF EMPLOYER, TELEPHONE NUMBER, JOB TITLE AND TYPE OF WORK, REASON FOR LEAVING, and DATES FROM TO.

part 2 to completing lic personal record

The software will require particulars to easily fill up the box CIRCLE HIGHEST YEAR COMPLETED, DIPLOMA, CURRENTLY ENROLLED IN HIGH SCHOOL, EDUCATION, YES IF YES GIVE EXPECTED, EMPLOYMENT RELATED EDUCATION, COURSE TITLE, NAME OF SCHOOL OR ORGANIZATION AND, NUMBER UNITS COMPLETED, DATE COMPLETED, CURRENTLY ENROLLED, LIC, and OVER.

stage 3 to finishing lic personal record

The NAME UNIVERSITY COLLEGE OR, MAJOR SUBJECT, COMPLETED COMPLETED CERTIFICATE, List names of three persons who, REFERENCES, NAME, ADDRESS, TELEPHONE NUMBER, RELATIONSHIP TO YOU FRIEND, A List Licenses or Certificates of, PROFESSIONAL AND TECHNICAL, and B Names of Professional segment may be used to point out the rights and responsibilities of both parties.

step 4 to completing lic personal record

Look at the fields NOTES and then fill them in.

Completing lic personal record stage 5

Step 3: Choose the Done button to save your document. Now it is readily available for transfer to your gadget.

Step 4: Come up with a duplicate of every document. It's going to save you some time and allow you to stay clear of misunderstandings down the road. Keep in mind, your data is not revealed or monitored by us.

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