Lic 508 2025

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The document is a Criminal Record Statement for applicants to the Long-Term Care Ombudsman Program in California. It requires individuals to disclose any criminal convictions, including those from other states or federal courts, while exempting certain marijuana-related offenses. The form emphasizes the importance of honesty in disclosing past convictions, as failure to do so may result in denial of exemption. It also includes instructions for both respondents and the Ombudsman office regarding the handling of disclosed information and privacy considerations.

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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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2011	4.8 Satisfied (165 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is a LIC 503?

The LIC 503 is required by the California Department of Social Services as part of the application process to work in a Community Care facility. It is used during the hiring process to verify the health of the applicant. It requires completion and signature by a physician.

What is lic 200?

Application for a Child Care Center License LIC 200A. Application For A Community Care Facility or Residential Care Facility For The Elderly License LIC 200.

What is the lic 500 form?

0:06 1:25 But its essential to ensure the site is reputable and reliable. Its important to note that someMoreBut its essential to ensure the site is reputable and reliable. Its important to note that some criminal records may be restricted or sealed limiting access to certain information.

What is the 7 year criminal background check rule in California?

After employers in California make a conditional employment offer, they may order a criminal background check that goes back only seven years (with some exceptions). Therefore, employers cannot see convictions older than seven years and cannot pass you over based on seven-plus old convictions.

What is a lic 508?

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.

lic508

LIC 9052 lic 508 (7/21) LIC 508 updated LIC 610A Lic 508 pdf LIC 508 Child Care LIC 508 no longer required LIC 501

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Do I have to disclose a felony after 7 years in California?

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES. PERSONNEL REPORT. INSTRUCTIONS: This form is intended for keeping a current roster of all the facility personnel, other adults and licensees residing in the facility, including backup persons, volunteers and licensee if administrator/director.

Lic 508 2025

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