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Get CA CDPH 322 2014-2024

, CA 95899-7416 (916) 327-2445 Fax: (916) 552-8854 Transmittal Application for Criminal Record Clearance Date sent: (See Live Scan process instructions on reverse) This form must be completed by the facility administrator or other authorized staff and submitted to the address above, or faxed using the Live Scan process on reverse. When criminal record clearance is approved, the individual named below will be cleared for employment or facility licensing purposes. The Department will mail a cri.

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