Lic 9214-2026

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167 votes

The document is an application form for the Administrator Certification Program by the California Department of Social Services, Community Care Licensing Division. It outlines the requirements and instructions for both new and renewal applicants seeking certification to manage various types of care facilities, including Adult Residential Facilities, Group Homes, and Residential Care Facilities for the Elderly. The form requires personal information, criminal record clearance details, and proof of training or continuing education.

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Click ‘Get Form’ to open the lic 9214 in the editor.
Begin by selecting the type of application you are submitting. Check either 'New' or 'Renewal' and provide your certificate number and expiration date if applicable.
Next, indicate the type of program you are applying for by checking one of the options: ARF, GH, RCFE, or STRTP.
Fill in your applicant information. Ensure all fields are completed accurately, including your name, address, telephone number, and email. If any information has changed since your last submission, check the appropriate box.
Answer the questions regarding previous licenses and employment history truthfully. This includes providing details about any legal actions if applicable.
For initial applicants only, select when you would like your certificate to expire.
Finally, certify that all information is correct by signing and dating the form at the bottom.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (104 Votes)
2016	4.3 Satisfied (167 Votes)
2016	4.2 Satisfied (55 Votes)
2012	4.3 Satisfied (121 Votes)
2006	4.3 Satisfied (57 Votes)

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