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INSTRUCTIONS: PERSONNEL REPORT - California …

SUBJECT TO CRIMINAL BACKGROUND CHECK REQUIREMENTS: The following staff members are subject to a criminal background check pursuant to Sections 1522, , of the Health and Safety Code. A California background clearance or a criminal record exemption shall be obtained prior to employment, residence or initial presence in the facility. SPECIFYDAYS AND HOURS ON DUTYDAYSFROMTOSTATE OF California HEALTH AND HUMAN services AGENCYCALIFORNIA department OF social SERVICESPERSONNEL REPORTINSTRUCTIONS: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. Show license/certificate number if applicable forspecialized staff [ , social Worker and other consultant(s)].

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. Show license/certificate number if applicable for

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  Social, Services, Department, Personnel, California, California department of social services

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