Form Lic 01a - Resource Family Application
Download a blank fillable Form Lic 01a - Resource Family Application 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 Form Lic 01a - Resource Family Application 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
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING
AGENCY USE ONLY
RF ID #: ________________
FFA: ___________________
RESOURCE FAMILY APPLICATION
Instructions: This is the application form for Resource Family Approval by a foster family agency. Please type or print clearly.
I
I
I
I
INITIAL APPLICATION
OTHER (SPECIFY) :
FIRST
LAST
MIDDLE
APPLICANT ONE:
PREVIOUS NAMES USED: *including maiden name
HIGHEST LEVEL OF EDUCATION COMPLETED
DRIVER’S LICENSE NUMBER
DATE OF BIRTH
GENDER
RACE/ETHNICITY
CELL PHONE NUMBER
HOME PHONE NUMBER
NAME/ADDRESS OF EMPLOYER
WORK PHONE NUMBER
ANNUAL INCOME
OCCUPATION
LAST
MIDDLE
FIRST
APPLICANT TWO:
HIGHEST LEVEL OF EDUCATION COMPLETED
PREVIOUS NAMES USED: *including maiden name
DRIVER’S LICENSE NUMBER
DATE OF BIRTH
GENDER
RACE/ETHNICITY
CELL PHONE NUMBER
HOME PHONE NUMBER
WORK PHONE NUMBER
ANNUAL INCOME
NAME/ADDRESS OF EMPLOYER
OCCUPATION
II. APPLICANT(S)’ RESIDENCE
CITY
STATE
PHYSICAL ADDRESS
CITY
STATE
MAILING ADDRESS (IF DIFFERENT)
I
I
I
Do you own, rent or lease the residence?
Check one:
Own
Rent
Lease
I
I
Weapons in the home?
Check one:
Yes
No
I
I
Body of Water
Check one:
Yes
No
If yes, please describe the location of the body of water and its size.
I
I
Does any person not listed in this document use the residence as their
Check one:
Yes
No
mailing address?
If yes, who: ______________________________
LIC 01A (2/17) (Mandatory)
RESOURCE FAMILY APPLICATION
PAGE 1 OF 4
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal