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STATE OF CALIFORNIA HEALTH AND HUMAN SERVICES AGENCY ... California Department of Social Services (CDs) processed criminal record background check, it is the licensee×39’s responsibility to submit
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How to fill out lic 198b form
01
To fill out LIC 198b, start by obtaining the form from the relevant licensing authority or agency. It may be available online or in person at their office.
02
Carefully read and understand the instructions provided with the form. This will ensure that you provide accurate and complete information.
03
Begin filling out the form by providing your personal details such as your name, address, contact information, and any other required identification information.
04
If applicable, indicate the purpose or reason for needing LIC 198b. This may include applying for a license, permit, or certification, or requesting a background check or clearance.
05
Fill in the necessary details regarding your education, work experience, or any other relevant qualifications required by the licensor.
06
Provide any supporting documentation or attachments as instructed. This may include copies of your identification, educational certificates, employment references, or any other relevant documents.
07
Double-check all the information you have provided to ensure accuracy and completeness. Any errors or omissions could delay or complicate the processing of your request.
08
Sign and date the form where indicated. This indicates that the information provided is true and accurate to the best of your knowledge.
09
Submit the completed form, along with any required fees, to the designated authority or agency as instructed. Keep a copy of the filled form and any supporting documents for your records.
Who needs LIC 198b?
01
Individuals who are applying for professional licenses or certifications may need LIC 198b. This may include doctors, nurses, lawyers, engineers, teachers, and other licensed professionals.
02
Employers or organizations that require background checks or clearances as part of their hiring process may request LIC 198b from their employees or prospective candidates.
03
Government agencies or licensing authorities may require LIC 198b for various administrative or legal purposes, including regulatory compliance, background investigations, or enforcement actions.
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What is lic 198b?
Lic 198b refers to a section or code in the California Business and Professions Code. However, there is no specific information available about this particular code section as it does not seem to exist or is not commonly referenced. It is possible that the reference might be typographical or incorrect.
Who is required to file lic 198b?
The California Department of Social Services requires licensed child care centers and family child care homes to file LIC 198B, which is the Application for a Child Care License.
How to fill out lic 198b?
Form LIC 198B is a disclosure of prior criminal convictions and pending criminal actions for individuals applying for a license from the California Department of Insurance (CDI). Here's how you can fill out the form:
1. Obtain Form LIC 198B: You can download the form from the CDI website or obtain a hard copy from the CDI office.
2. Applicant Information: Fill out your personal information, including your full name, mailing address, phone number, and email address.
3. Criminal Convictions: List any criminal convictions you have. Start with the most recent conviction and continue in reverse chronological order. Provide details such as the date of conviction, offense description, the name and location of the court, and the sentence received.
4. Pending Criminal Actions: If there are any pending criminal actions against you, provide the details of those cases. Include information such as the offense description, the name and location of the court handling the case, and any scheduled court dates.
5. Criminal Offenses Explanation: Explain the circumstances surrounding each conviction or pending action in the space provided. Be concise but informative, and include any relevant details that provide a clear understanding of the incidents.
6. Supporting Documentation: Attach copies of all official court documents pertinent to your convictions or pending actions. This may include court records, judgments, probation orders, sentencing documents, or any other relevant documents.
7. Declaration: Read the declaration statement at the bottom of the form carefully. Sign and date the form to affirm that all the information provided is true and accurate to the best of your knowledge.
8. Submitting the Form: Make a copy of the completed LIC 198B form and all the supporting documents for your records. Send the original form and attachments to the CDI address specified on the form. It is advisable to send the form via certified mail or another trackable method to ensure delivery.
Remember, filling out Form LIC 198B honestly and providing complete information is crucial. Failure to disclose prior convictions or pending actions accurately may result in the denial of your license application. If you have any doubts or questions, consider seeking guidance from a legal professional or contacting the CDI for assistance.
What is the purpose of lic 198b?
LIC 198B refers to a form used for reporting changes in employment conditions for registered nurses (RNs) and licensed vocational nurses (LVNs) who work in health facilities in California. The purpose of LIC 198B is to ensure that the California Board of Registered Nursing (BRN) and the California Board of Vocational Nursing and Psychiatric Technicians (BVNPT) are properly informed about any significant changes in an RN or LVN's employment.
The form requires the nurse to disclose information regarding their employment, such as changes in job title, hours of work, and supervisory responsibilities. This information helps the boards to monitor and regulate the practice of nursing in the state, ensuring that nurses and health facilities abide by the relevant laws and regulations.
By submitting LIC 198B, nurses enable the boards to keep accurate records of their employment, and this in turn facilitates regulatory oversight, license issuance, and renewal processes.
What information must be reported on lic 198b?
The LIC 198B form is used for reporting an employee's criminal record clearance information in a Licensed Community Care Facility. The information that must be reported on the form includes:
1. Facility Information: This includes the name and address of the licensed facility and the facility number.
2. Employee Information: This includes the name, date of birth, social security number (or assigned identification number) of the employee, and the position they hold at the facility.
3. Criminal Record Clearance Information: This section requires the reporting of criminal record clearance check results for the employee. This includes indicating whether the employee has been fingerprinted and has undergone a criminal background check. It also requires reporting any criminal convictions or arrests, including the nature of the offense, the date, and the disposition or current status of the case.
4. Exemptions or Exceptions: This section should be completed if the employee has been granted any exemptions or exceptions by the Community Care Licensing Division. This may include exemptions for certain offenses, rehabilitation certificates, or other special circumstances.
5. Declaration: The final section requires the signature of the licensee or designee, confirming that the information provided is true and accurate to the best of their knowledge.
It is important for the licensee to complete this form accurately and thoroughly as part of their responsibilities in ensuring the safety and well-being of residents in the licensed facility.
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