Lic 508 2026

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The document is a Criminal Record Statement from the California Department of Social Services, requiring individuals associated with licensed facilities to disclose any criminal convictions. It outlines the necessity of fingerprinting and details the implications of failing to disclose such information, including potential denial or revocation of licenses. The form also includes instructions for respondents and licensees regarding the disclosure process and emphasizes the importance of accuracy under penalty of perjury.

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Click ‘Get Form’ to open the lic 508 in the editor.
Begin by filling in your personal information, including your name, address, and date of birth. Ensure that all details are accurate and clearly printed.
Indicate whether you have ever been convicted of a crime in California or any other jurisdiction by selecting 'YES' or 'NO'. If you select 'YES', be prepared to provide additional details on the back of the form.
If applicable, detail each conviction on the reverse side, including the nature of the offense, location, and date. Use additional sheets if necessary.
Complete the signature section at the bottom of the form, certifying that all information provided is true and correct under penalty of perjury.

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