Lic 9163 2008 form-2026

1. Click ‘Get Form’ to open the lic 9163 2008 form in the editor.
2. Begin by filling in the ORI field, which is preprinted as A0448. This identifies your application.
3. In the Working Title section, check the appropriate box that describes your role: Adult Resident, Employee, License/Certification Applicant, or Volunteer.
4. For Authorized Applicant Type, refer to Page 2 of the form and select your facility type from the provided list. Enter its corresponding DOJ abbreviated facility type.
5. Complete the Agency Address section with the preprinted information for CA Dept of Social Services. Ensure all details are accurate.
6. Fill out your personal information in the Applicant Information section. Include your full name, date of birth, sex, height, weight, and any other required identifiers.
7. If applicable, provide your Employer's details in Section 7. This includes their name and address.
8. Finally, ensure that you take this form to your Live Scan appointment for completion by the operator.

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