Get Lic 9163

The Lic 9163 form is a critical document used for electronic fingerprinting for community care licensing applicants in California. This guide provides a structured approach to completing the form online, making the process straightforward and easy to follow.

Follow the steps to complete the Lic 9163 form accurately.

1. Click the 'Get Form' button to access the Lic 9163 form and open it in your preferred online editor.
2. In the ORI section, confirm that the code A0448 is printed correctly, as this identifies the purpose of the fingerprinting.
3. For the title/position, mark the checkbox that applies to you, such as 'Adult resident not a client', 'Employee', 'License/certification applicant', or 'Volunteer'.
4. Specify the type of authorized applicant. Refer to the list provided on page 2 to select the most relevant establishment type and enter the corresponding DOJ abbreviation.
5. Fill in the address of the office contributing to the submission, including the department name, P.O. Box number, and appropriate city, state, and postal code details.
6. Provide your personal information by writing your full name, date of birth, sex, height, weight, eye color, hair color, place of birth (POB), and social security number (optional). Make sure to use uppercase letters for clarity.
7. Enter the establishment number and indicate the service level, which should already be filled in for you. If this submission is a reprint due to the quality of fingerprints, include the original ATI number.
8. If applicable, fill out your employer's information, including their name, address, and phone number.
9. Lastly, ensure the 'Live Scan Transaction Completed By' section is completed by the operator during your fingerprinting session. Note the details they provide.

Complete your Lic 9163 form online today and ensure a smooth application process.