1. What is the purpose of the Lic 215 form?
The Lic 215 form is used by individuals seeking a facility license in California. It collects essential information about the applicant, including their personal details, educational background, work history, and any professional licenses they may hold. This information helps the California Department of Social Services assess the qualifications of the applicants.
2. Who needs to fill out the Lic 215 form?
All applicants for a facility license must complete the Lic 215 form. This includes individuals, partners in a partnership, and authorized representatives of a corporation. Each person involved in the licensing process must provide their information to ensure compliance with state regulations.
3. Is it necessary to provide my Social Security number?
Yes, if applicable, your Social Security number is required on the Lic 215 form. Federal law mandates that agencies must inform individuals whether providing this number is mandatory or voluntary. In this case, it is necessary for identification and verification purposes during the licensing process.
4. Can I submit additional information if necessary?
Absolutely. If you require more space than what is provided on the form, you can attach additional sheets. Just be sure to indicate the relevant section of the Lic 215 form that corresponds with the extra information for clarity.
5. What information is required regarding my education?
The form asks for your highest completed level of education, the name and location of your high school or college, and any degrees earned. This information is vital as it demonstrates your educational qualifications relevant to the type of facility you are seeking to operate.
6. Are there any questions related to prior licensing status?
Yes, the Lic 215 form includes questions about your history with previous licenses for various types of facilities. You will need to disclose if you have held any licenses or beneficial ownership roles and whether disciplinary actions were ever taken against you. This information aids in the overall assessment of your suitability for licensure.
7. What details should I include about my work experience?
You should list all relevant work experiences for the past seven years, along with any periods of unemployment. This section needs to include the name and address of your employer, your basic duties, and reasons for termination. If your work experience extends beyond seven years, it can be included as well, especially if it is pertinent to your application.
8. Is it important to provide references?
Yes, you must provide both personal and financial references. These references help verify your administrative capabilities and financial practices. For personal references, include past employers. Financial references should be individuals familiar with your business resources.
9. What if I have a medical condition? Do I have to disclose it?
The Lic 215 form does ask whether you have any medical, physical, or mental conditions that could impair your ability to provide care. Honesty is crucial, as this information is necessary for evaluating your capability to care for the residents or clients you intend to serve.
10. How is the information on the Lic 215 form protected?
While the form collects sensitive information, it is subject to privacy regulations. The California Department of Social Services adheres to specific rules regarding the handling of personal information, ensuring it is used solely for the purpose of the licensing process. If you have concerns about privacy, inquire about the agency's policies regarding data protection.