Resource Family Application - California Department Of Social Services Page 4
Download a blank fillable Resource Family Application - California Department Of Social Services in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Resource Family Application - California Department Of Social Services with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
VIII. REFERENCES
FULL NAME
TELEPHONE NUMBER(S)
MAILING ADDRESS/CITY/STATE/ZIP
IX.
APPLICANT(S) DECLARATION
I/We declare that:
I/We have the financial ability to maintain the level of care required in a Resource Family Home.
G
I/We have the ability and willingness to comply with the applicable laws, regulations, and Written Directives governing the
G
Resource Family Approval Program.
I/We understand that children and nonminor dependents have personal rights under Welfare and Institutions Code section
G
16001.9, and I/we have the ability and willingness to safeguard those rights.
I/We have the ability and willingness to understand the safety, permanence, and well-being needs of children and
G
nonminor dependents who have been victims of child abuse and neglect, and the capacity and willingness to meet those
needs, including the need for protection.
I/We have the ability and willingness to understand my/our role as a Resource Family and the capacity to work cooperatively
G
with the agency, county, and other service providers in implementing the child’s or nonminor dependent’s case plan.
I/We have an ability and willingness to maintain the least restrictive and most family-like environment that serves the needs of
G
the child or nonminor dependent, and am/are prepared to use the Reasonable and Prudent Parent Standard (RPPS).
•
In signing this application, I/we understand that the completion of routine forms will be required by my/our references,
physician, and employer, that my/our financial and marital status will be verified and a criminal background check will be
conducted.
•
I/We affirm that the information provided on this form is true and correct to the best of my/our knowledge.
•
I/We understand that I/we have the right to appeal any decision regarding the disposition of this application.
CITY AND COUNTY WHERE SIGNED
APPLICANT(S) SIGNATURE
DATE
RFA-01(A) (11/14)
PAGE 4 OF 4
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Tlr 1 - Trustline Registry In-home/license Exempt Child Care Provider Program California Department Of Social Services Background Check Application
Legal
Form Ad 504 Relinquishment Out-of-state In Armed Forces - California Department Of Social Services
Legal
Related Categories
Parent category: Legal