Lic 809 2025

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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.
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES. PERSONNEL REPORT. INSTRUCTIONS: This form is intended for keeping a current roster of all the facility personnel, other adults and licensees residing in the facility, including backup persons, volunteers and licensee if administrator/director.
The LIC 503 is required by the California Department of Social Services as part of the application process to work in a Community Care facility. It is used during the hiring process to verify the health of the applicant. It requires completion and signature by a physician.
California prohibits CRAs from reporting convictions older than seven years under Cal. Civ. Code 1786.18(a)(7). This law also prohibits CRAs from reporting arrests not leading to convictions even if they occurred within the last seven years, but pending cases can be reported.
EMERGENCY DISASTER PLAN FOR CHILD CARE CENTERS. Post a copy in a prominent location in facility, near telephone. Licensee is responsible for updating information as required.
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Additional child abuse/neglect check for persons who have lived out of state in the last five years. Complete one form for each prospective licensed or certified foster parent and any person over the age of 18 residing in their household. LIC 198B (3/11)

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