Form LIC 500, Personnel Report is a state-specific form filled out to provide a current list of the personnel employed on the facility. Besides the employees, the list has to include backup persons, volunteers, and other adults and licensees residing in the facility. Download the up-to-date fillable Form LIC 500 through the link below.
The document was issued by the Community Care Licensing Division within the California Department of Social Services (CDSS). The latest revision of Form LIC 500 was released on November 1, 2003.
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