Form LIC279B "Current Children in Your Home Application for a Family Child Care Home License" - California

What Is Form LIC279B?

This is a legal form that was released by the California Department of Social Services - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2005;
  • The latest edition provided by the California Department of Social Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form LIC279B by clicking the link below or browse more documents and templates provided by the California Department of Social Services.

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Download Form LIC279B "Current Children in Your Home Application for a Family Child Care Home License" - California

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
CURRENT CHILDREN IN YOUR HOME
APPLICATION FOR A FAMILY CHILD CARE HOME LICENSE
Please list the name, date of birth, sex and relationship of each child living in your home. This form is intended for agency
use only and is relevant to the Application for a Family Child Care Home License, LIC 279.
The information contained in this form is not public. This form will be filed in the confidential section of the facility file.
CHILD’S FULL NAME
DATE OF BIRTH
SEX
RELATIONSHIP
LIC 279B (10/05) PERSONAL/CONFIDENTIAL
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
CURRENT CHILDREN IN YOUR HOME
APPLICATION FOR A FAMILY CHILD CARE HOME LICENSE
Please list the name, date of birth, sex and relationship of each child living in your home. This form is intended for agency
use only and is relevant to the Application for a Family Child Care Home License, LIC 279.
The information contained in this form is not public. This form will be filed in the confidential section of the facility file.
CHILD’S FULL NAME
DATE OF BIRTH
SEX
RELATIONSHIP
LIC 279B (10/05) PERSONAL/CONFIDENTIAL