Get Lic 500

The Lic 500 form is essential for personnel records within California's health and human services sector. This guide will provide you with comprehensive, step-by-step instructions for completing the Lic 500 online, ensuring an efficient and accurate submission.

Follow the steps to successfully complete the Lic 500 online.

1. Click the ‘Get Form’ button to access the Lic 500 form and open it in your preferred editing program.
2. Begin by filling out the personal section. Enter your full name, telephone number, and address. Confirm your age by indicating whether you are 18 years of age or older.
3. Provide your social security number, which is voluntary for identification purposes. Include the date of your last physical examination and details regarding any previous employment under a different name, if applicable.
4. In the position section, indicate your job title, salary, date of employment, working hours, and supervisor’s name.
5. For the previous employment section, list your work experience starting with the most recent. Provide contact numbers, dates of employment, job titles, types of work, and reasons for leaving.
6. Complete the education section by circling the highest year completed and listing any employment-related education courses or degrees earned, along with completion dates.
7. In the references section, include the names, addresses, telephone numbers, and relationships of three individuals who can provide information regarding your background.
8. State your professional and technical qualifications, including any licenses or certificates held and professional associations.
9. Sign and date the form to certify the accuracy of your information under penalty of perjury.
10. Once the form is completed, you can save any changes made, download it for your records, print it, or share it as needed.

Complete your Lic 500 form online today to ensure your compliance with California's health and human services regulations.