Form LIC9182 Criminal Background Clearance Transfer Request - California

Form LIC 9182 Instructions

The instructions for the Criminal Background Clearance Transfer Request include the following:

1. Use this form to request only a transfer of an active criminal record clearance. If you need to transfer an active exemption, submit Form LIC 9188, Criminal Record Exemption Transfer.
2. Fill out Form LIC 9182 to transfer clearance between state-licensed facilities only. To request a transfer from the TrustLine Registry, use Form TLR 3, Trustline to Community Care Licensing Criminal Background Clearance Transfer Request.
3. You may request a transfer of criminal background clearance to more than one facility on one form. For this purpose, attach a list containing the facility number for each facility to which the clearance should be transferred.
4. The form must be submitted before the individual subject to transfer has asses to the facility clients.
5. If the individual starts working at the facility before the Criminal Background Clearance Transfer Request is submitted, the community care facility or organization will be subject to a civil penalty. The amount of the penalty is $100.
6. The licensee or the license applicant must attach Form LIC 508 and a copy of the permanent resident card, the individual's driver's license, or any valid photo identification to Form LIC 9182. Moreover, if the individual is transferred to a facility serving children, a Child Abuse Central Index Check must be submitted.
7. The Social Security number (SSN) box on this form is optional. However, it is often used as an identifying number and failure to provide the SSN may delay the processing of this transfer request.
8. The individual seeking for transfer does not need to wait for a confirmation of the clearance transfer. As soon as the transfer request form is submitted, the individual can start working in the facility.

Where to Send LIC 9182?

Submit the form to a local CCLD office. Find the list of all local offices and their contact information on the California Department of Social Services (CDSS) website. Individuals who wish to receive a community care license, provide services, work or reside in a licensed community care facility will need to fill out two more forms:

• Form LIC 508, Criminal Record Statement. Use this form to provide a truthful and complete history of any criminal record you may have. The exception is minor traffic violations;
• Form LIC 9108, Statement Acknowledging Requirement to Report Suspected Child Abuse. Fill out this document to state that you understand your responsibility as a licensee or an employee at a childcare institution or a licensed facility to report known or suspected child abuse cases.