Lic 508 2011 form-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 and undergo fingerprinting for background checks. It outlines the necessity of reporting all convictions, including misdemeanors and those from other jurisdictions, while exempting certain marijuana-related offenses. The form emphasizes the consequences of failing to disclose convictions and includes instructions for both respondents and licensees regarding the handling of disclosed information.

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Click ‘Get Form’ to open the lic 508 2011 form in the editor.
Begin by filling out 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 by selecting 'YES' or 'NO'. If 'YES', provide detailed information on the back of the form as instructed.
Repeat the process for any convictions from other states or jurisdictions. Remember to include all necessary details about each offense.
Complete the signature section at the bottom of the form, certifying that your responses are true and correct under penalty of perjury.

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Versions	Form popularity	Fillable & printable
2015	4.8 Satisfied (86 Votes)
2011	4.4 Satisfied (511 Votes)
2003	4.1 Satisfied (64 Votes)
2000	4.4 Satisfied (25 Votes)

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I/We hereby declare that I/We have not served on any Office of the Life Insurance Corporation of India any Notice of assignment or reassignment in respect of the above POLICY/ POLICIES except those, if any already Registered by the Life Insurance Corporation of India or the Insurer who issued the above POLICY/POLICIES

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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.