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Get LIC 9142a - California Department Of Social Services - Dss Cahwnet

Complete a separate roster for each day of course instruction. 744 P Street M. S. 19-47 Sacramento CA 95814 Course Program Type Check one box RCFE Initial 40-Hour Course RCFE CEU ARF Initial 35-Hour Course ARF CEU Vendor Name Instructor s Name Course Name GH Initial 40-Hour Course GH CEU Location of Course Last Name of Participant Print Name of Authorized Representative Print LIC 9142A 3/06 Time In Facility Name or Facility License Time Out P.

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