Lic 500 form 2025

1. Click ‘Get Form’ to open the lic 500 form in the editor.
2. Begin by entering the establishment name, type, and number in the designated fields at the top of the form.
3. In section A, list all employees subject to background checks. Fill in their names, employment dates, job titles, and specify their service days and hours.
4. For section B, identify employees exempt from background check requirements. Ensure you provide their names and employment details as well.
5. The licensed person or administrator must sign and date the form at the bottom of section B to verify exemptions.
6. Once completed, save your changes and download a copy for your records before submitting the original to the licensing office.

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