Form LIC 9182. Criminal Background Clearance Transfer Request - California

Form LIC 9182 is used in California to request the transfer of a criminal background clearance from one facility or program to another within the scope of Community Care Licensing. This form is completed by individuals who have obtained a criminal background clearance and need it to be transferred to a different facility or program.

The form consists of sections that require the individual's personal information, details about the current facility/program, and information about the receiving facility/program. Important fields include the individual's full name, contact information, identification numbers related to their existing clearance, and the relevant information regarding both the current and receiving facilities/programs. It is crucial to accurately provide all necessary information to ensure a smooth transfer process and maintain compliance with Community Care Licensing requirements for background clearances.

An application example of this form would involve an individual completing Form LIC 9182 to request the transfer of their criminal background clearance from their current facility/program to a new one. They would provide their personal information, specify their existing clearance details, and provide information about both the current and receiving facilities/programs. By successfully submitting this form, the individual can initiate the transfer process and ensure that their background clearance remains valid within their new facility/program.