Lic9141 2004 form-2025

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The document is an application form for becoming or renewing a course vendor in the Administrator Certification Program by the California Department of Social Services. It outlines the necessary steps, including submitting a completed application and processing fee, specifying the type of program and vendor, and providing applicant information. The form also includes sections for certification and legal disclosures related to previous licenses or employment in state-licensed care facilities.

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Versions	Form popularity	Fillable & printable
2016	4.9 Satisfied (452 Votes)
2004	4.1 Satisfied (69 Votes)

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