CA HHSA DSS LIC 9215 2012-2024 free printable template

To receive an extension of your time to renew your CDS administrator certificate through the Administrative Review, you must submit a request signed by your primary caregiver to: CDs Case Manager Social Services Administration 200 N. 7th Street Suite 1010 Sacramento, CA 95 Telephone: Fax: Email: Please provide your full name along with a valid email address and return a copy of the completed form. The administrative appeal process for a CDs administrator certificate is outlined in the Administrative Review guidelines. SUMMARY OF BACKGROUND CHECK QUESTIONS Answers to background check questions must be submitted in order to proceed to the initial review phase of the application process. You are not required to provide a completed background check. However, submitting a completed report is important for the California Department of Social Services to have an appropriate record that you are eligible to remain certified as a social services administrator and to determine whether an immediate renewal is needed. In addition, submitting a completed background check helps ensure that the records held by your local California Department of Social Services' agency are correctly complete once your application is processed by other state agencies. It also provides an accurate record of your prior offenses and convictions that would affect your ability to serve the public as a social services administrator. If you do not want to submit a complete background check, you can include a copy of your CDs case file or a certified copy of your most recent criminal history report.