Form LIC 9163. Request Live Scan Service - Community Care Licensing - California

Form LIC 9163 is used in California to request Live Scan services for individuals associated with Community Care Licensing. This form is completed by individuals who require background checks as part of their involvement in Community Care Licensing programs.

The form consists of sections that require the individual's personal information, demographics, and the type of position or role they hold within Community Care Licensing. Important fields include the individual's full name, contact information, date of birth, Social Security number, and the reason for the Live Scan request. It is crucial to accurately provide all necessary information to facilitate the background check process and ensure compliance with Community Care Licensing requirements.

An application example of this form would involve an individual completing Form LIC 9163 to request Live Scan services for their involvement in Community Care Licensing. They would provide their personal information, specify the position or role they hold within Community Care Licensing, and state the reason for the Live Scan request. By successfully submitting this form and undergoing the required Live Scan process, the individual can demonstrate their eligibility and suitability for participation in Community Care Licensing programs.