Form LIC 501, Personnel Record, is a legal document completed by every community care employee to provide an employer with information concerning the employee's personal details and employment experience. It serves as an employment application and is kept in an employee personnel file to be later used to assess the employee's qualifications for employment, transfer, promotion, compensation, and disciplinary action.
This form was released by the California Department of Social Services (CDSS), a component of the California Health and Human Services Agency (CHHS). The latest version of the form was issued on March 1, 1999, with all previous editions obsolete.
You can download a fillable LIC 501 Form through the link below. If you prefer to complete a Spanish version of the document, download Form LIC 501 (SP), Historial de Empleo/Educacion, on our website using this link.
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