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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. A conviction is any plea of guilty or nolo contendere (no contest) or a verdict of guilty.
CPIC Investigative Data Bank Police Information Portal (PIP) OTHER: AUTHORIZATION AND WAIVER to provide a confirmation of criminal record or any police information. This form is required to be filled out and attached to your Informed Consent Form for a Criminal Record Verification.
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