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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.

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How to fill out the Lic 9163 Pdf Filler online

Completing the Lic 9163 form is an essential step for individuals seeking Live Scan services through community care licensing in California. This guide provides clear, step-by-step instructions on filling out the Lic 9163 Pdf Filler online, ensuring that you can navigate the process efficiently and accurately.

Follow the steps to fill out the Lic 9163 form online.

  1. Click the ‘Get Form’ button to obtain the Lic 9163 form, which you can open in your preferred online editor.
  2. Locate the ORI field at the top of the form, which is preprinted as 'A0448'. Verify this information is correct.
  3. In the Working Title section, check the box that corresponds with your role: 'Adult Resident other than Client', 'Employee', 'License, Certification, Applicant', or 'Volunteer'.
  4. For the Authorized Applicant Type, refer to page 2 of the document to choose the facility type where you will be working. Enter the corresponding DOJ abbreviated facility type.
  5. Fill in the Agency Address, which is preprinted as the CA Department of Social Services. Include the Mail Code and ensure the contact details are accurate.
  6. Complete the Applicant Information section by printing your full name, date of birth, sex, height, weight, and California driver's license number. Also, include any other miscellaneous identification numbers, including a social security number if applicable.
  7. Enter the Facility Number in the designated section. If applicable, indicate the level of service required and any previous ATI numbers if this is a resubmission.
  8. Fill out the Employer section with the employer's name, address, and optional telephone number if you are being printed for a specific employer.
  9. The Live Scan transaction information will be completed by the Live Scan operator. Remember to take the completed form with you on your fingerprinting day.
  10. After filling out the form, review all entries for accuracy. You can then save your changes, download the form, print it, or share it as necessary.

Complete your documents online today for a smoother processing experience.

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POB - Indicate the state or country of birth. SOC - Enter your social security number. CDL - Enter your California Driver's license number. Box 4: Level of Service – If you are submitting fingerprints with your initial application to the Board, indicate both DOJ and FBI by placing an "X" in each box.

Name of Applicant: Last Name, First Name and Middle Initial Other Name (AKA or Alias): Last and First Date of Birth: Indicate month-day-year of birth Sex: Check either Male or Female Driver's License Number: Indicate your California Driver's License Number Height: Indicate your height in feet and inches Weight: ...

SOC: Social Security Number. Driver's License No.: California driver's license number. If you do not have a California driver's license, enter other identifying numbers such as another state driver's license number or California ID card number.

How can an applicant check their Live Scan status? DMV cannot release a license or permit until the applicant passes a background check from DOJ. Applicants may check the status of their Live Scan application at https://applicantstatus.doj.ca.gov. Applicants will need to enter their ATI # and date of birth.

Individuals can obtain a Request for Live Scan form LIC 9163 or from any local Community Care Licensing Division office. This form will automatically request a Child Abuse Central Index (CACI) check if needed.

What does "CDL No." on my Live Scan form mean? CDL No. stands for California driver's license number. You need to write in your California driver's license number in the space provided.

SOC: Social Security Number.

Place of Birth (POB) – Enter the US state of the country of birth if place of birth is out of the US.

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