Lic 508 2026

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The document outlines the requirements for individuals applying to participate in the Long-Term Care Ombudsman Program in California, specifically regarding the disclosure of criminal convictions. It mandates fingerprinting and a comprehensive background check, including any convictions from California or other jurisdictions. Certain marijuana-related offenses are exempt from disclosure. The document emphasizes the importance of honesty in reporting past convictions, as failure to disclose may result in denial of exemption. Additionally, it includes instructions for respondents and privacy information related to the handling of personal data.

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Click ‘Get Form’ to open the lic 508 in the editor.
Begin by answering the first question regarding any convictions in California. Select 'YES' or 'NO' as applicable.
If you answered 'YES', provide details on the back of the form about each conviction, including nature, circumstances, date, and location.
Next, answer whether you have been convicted of a crime from another state or jurisdiction. Again, select 'YES' or 'NO'.
If applicable, repeat the detailing process for any out-of-state convictions on additional sheets if necessary.
Fill in your personal information: name, address, social security number, date of birth, DMV license number.
Finally, sign and date the form to certify that all information provided is true and correct.

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What is the lic 508 form?

CRIMINAL RECORD STATEMENT OUT-OF-STATE DISCLOSURE. LIC 508 (7/21) Page 1 of 5 State law requires that persons associated with licensed care facilities, Home Care Aide Registry or TrustLine Registry applicants be fingerprinted and disclose any conviction.

What is lic 602?

The LIC 602A form is a Physicians Report for Residential Care Facilities for the Elderly (RCFE) in California. It determines if an individual is medically fit for assisted living. Required by the California Department of Social Services (CDSS), it ensures proper care levels for residents.

What is LIC 827 policy?

LIC Jeevan Rakshak Plan 827 Key Features Death coverage of the policy includes Sum Assured on Death + Loyalty additions, if the death occurs after the completion of 5th policy year. On the other hand if the death occurs within 5 policy years, only Sum Assured on death shall become payable.

Is the LIC 508 discontinued?

Effective January 1, 2023, the PIN discontinues the use of the LIC 508 form for collecting criminal history information as part of the background check process.

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