Get Ca Lic 9163 2008

The CA LIC 9163 form is essential for individuals applying for Live Scan services within the Community Care Licensing framework. This guide provides step-by-step instructions to help you successfully fill out the form online, ensuring all necessary information is accurately provided.

Follow the steps to complete the CA LIC 9163 online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Locate the Originating Response Indicator (ORI), which is preprinted as ‘A0448’.
3. In the Working Title section, check the appropriate box that corresponds to your role, such as 'Adult Resident other than Client', 'Employee', 'License, Certification, Applicant', or 'Volunteer'.
4. For the Authorized Applicant Type, refer to the list on Page 2 to select the appropriate DOJ abbreviated facility type relevant to your employment.
5. Fill in the agency address, which includes the CA Dept of Social Services, P.O. Box 944243, Mail Station 19-62, Sacramento, CA 94244-2430. The Mail Code is preprinted as ‘03502’.
6. In the Applicant Information section, print your full name in the designated fields for last name, first name, and middle initial. Include any aka’s, your date of birth, and gender.
7. Provide personal details such as height, weight, eye color, and hair color. If applicable, enter your California driver’s license number and any other identification numbers.
8. Enter your complete home address, including street, city, state, and zip code. Optionally, include your state or country of birth and social security number.
9. Input the facility number or assigned OCA number in the designated section.
10. Select the level of service from the options provided, noting that if a Child Abuse Central Index check is needed, it will be completed by DOJ without additional input needed.
11. If this submission is a resubmission due to fingerprint quality, enter the original Applicant Tracking Information (ATI) number.
12. In the Employer section, fill in the name and address of your workplace as required, including the agency telephone number if available.
13. The Live Scan Transaction Completed By section should be filled out by the Live Scan operator when you attend your appointment. Retain a copy for your records.
14. Once you have completed the form, ensure all information is accurate. You can then save your changes, download a copy for your records, print the form, or share it as required.

Start filling out your CA LIC 9163 form online today.