Transcription of REQUEST FOR LIVE SCAN SERVICE - COMMUNITY …
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REQUEST FOR LIVE SCAN SERVICE - COMMUNITY …
STATE OF CALIFORNIA - HEALTH AND HUMAN services AGENCY CALIFORNIA DEPARTMENT OF social services . REQUEST FOR live scan SERVICE - COMMUNITY CARE LICENSING. Applicant Submission 1. ORI: A0448. 2. Working Title: (Check one). Adult Resident other than Client Employee License, Certification, Applicant Volunteer Home Care Aide Registry Applicant 3. Authorized Applicant Type - Enter from list on Page 2, DOJ Abbreviated CCLD Facility/Organization Type.. 4. Agency Address Set Contributing Agency: CA Dept of social services 03502.
7. Employer: (Additional response for Department of Social Services, DMV/CHP licensing, and Department of Corporations submissions only)Employer Name Street No. Street or PO Box Mail Code (five digit code assigned by DOJ)
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