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O. Box 603 San Francisco CA 94101 telephone 415 703-4810. Detach Here ------------------------------------------------------------------------------------------------- This form is to be retained in the employee s file This is to acknowledge that I have received a copy of PLEASE PRINT NAME OF EMPLOYEE licensee or authorized representative of SIGNATURE OF EMPLOYEE LIC 9052 3/03 DATE. STATE OF CALIFORNIA HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES NOTICE EMPLOYEE...
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How to fill out lic 9052 form

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How to fill out LIC 9052:

01
Begin by carefully reading the instructions provided with the LIC 9052 form.
02
Fill in your personal information accurately and legibly, including your name, address, contact details, and any other required information.
03
Provide any necessary details related to the purpose of filling out the form, such as the reason for the request or any specific requirements mentioned.
04
If the form requires you to disclose any financial or employment information, ensure that you provide accurate and up-to-date details.
05
Review your completed form to ensure all fields have been filled out properly and that there are no mistakes or missing information.
06
Sign and date the form as required, and include any additional supporting documents or attachments if requested.
07
Make a copy of the completed form for your records before submitting it to the designated authority or organization.

Who needs LIC 9052:

01
Individuals who wish to request specific services or permissions from a designated authority may need to fill out LIC 9052.
02
Companies or organizations that are required to provide certain information or documentation to regulatory bodies or government agencies may also need to complete this form.
03
LIC 9052 may be necessary in various situations, like government license applications, permit requests, financial transactions, or official requests for information.
Remember, it is always advisable to consult the relevant instructions or seek professional advice if you have any doubts or specific questions related to filling out LIC 9052.

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Instructions and Help about notice of employee rights lic 9052 form

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Lic 9052 is a type of business license issued by the California Department of Tax and Fee Administration. It is a general business license for taxable businesses operating in California.
Lic 9052 is an annual report of unclaimed property that must be filed by all businesses and organizations that maintain property belonging to another person or entity. This includes businesses, non-profit organizations, and government entities.
The deadline to file Lic 9052 for the 2023 tax year is April 15, 2024.
The penalty for the late filing of Form 9052 is a fine of up to $250, plus interest. Additionally, the filer may be subject to other penalties, such as a suspension of their license.
To fill out LIC 9052 form, follow the steps below: 1. Obtain the form: Download LIC 9052 form from the California Department of Social Services website or obtain a physical copy from your local licensing agency. 2. Provide facility information: Fill in the facility name, address, and phone number. If you have an identification number or license number, include it in the appropriate field. 3. Indicate the type of licensee: Check the box that corresponds to your licensee type, such as individual, partnership, corporation, or government agency. 4. Provide operator information: Fill in the name, address, phone number, and email of the facility operator. 5. Check the applicable boxes: Read through the list of options and check the boxes that apply to your facility. This includes the type of care provided, ages served, and any additional services offered. 6. Provide additional facility information: Fill out the facility capacity, hours of operation, and any other pertinent information requested. 7. Disclosure of ownership or control: If there are more than four owners or individuals with control, attach additional pages with their information. Otherwise, provide the necessary details for up to four individuals. 8. Criminal record statement: Answer the questions regarding criminal records for the facility operator and other individuals involved in the management, operation, or administration of the facility. 9. Declaration: Review the declaration statements and sign and date the form. 10. Notary acknowledgment: If required, have the form notarized by a public notary. 11. Submit the form: Make a copy of the completed LIC 9052 form for your records and submit the original to the appropriate licensing agency along with any required accompanying documents or fees. Note: It is advisable to read the instructions provided with the form and consult with the licensing agency or a legal professional if you have any specific questions or concerns while filling out LIC 9052.
Lic 9052 refers to a specific form titled "Child Care Agreement" provided by the California Department of Social Services, Community Care Licensing Division. The purpose of this form is to outline and establish an agreement between a licensed child care facility and the child's parent or guardian. The lic 9052 form includes important details such as the name and address of the child care facility, the child's information, the agreed-upon rates and fees, hours of operation, pick-up and drop-off procedures, health and safety requirements, and any additional terms and conditions. This document ensures that both parties are aware of their rights and responsibilities and helps maintain clear communication between the child care provider and the parent or guardian. It serves as an essential agreement to ensure the child's well-being and proper care while attending the child care facility.
The form LIC 9052 is the Community Care Licensing Facility Evaluation Report. It is used by the evaluator to report the findings of a facility evaluation. The information that must be reported on LIC 9052 includes: 1. Facility details: Name, address, and telephone number of the facility being evaluated. 2. Evaluation details: Date and time of the evaluation, and the name and title of the evaluator. 3. Activities observed: A detailed description of the activities observed during the evaluation, including any deficiencies or areas of concern. 4. Fire and life safety: Details about the facility's compliance with fire and life safety regulations, including the presence and proper functioning of fire extinguishers, smoke detectors, and emergency evacuation plans. 5. Safety hazards: Identification of any safety hazards found during the evaluation, such as unsafe equipment or environmental hazards. 6. Health and sanitation: Details regarding the cleanliness and sanitation of the facility, including food storage and preparation areas, restrooms, and general living spaces. 7. Staffing: Information about the facility's staffing levels and the qualifications of the staff present during the evaluation. 8. Resident records: Evaluation of the facility's resident records, including documentation of medical and care-related information. 9. Licensing and compliance information: Review of the facility's compliance with licensing regulations and any prior enforcement actions or complaints. 10. Recommendations and corrective actions: Any recommendations for improvement or required corrective actions to address deficiencies found during the evaluation. It is important to note that this information is a general summary of the required reporting elements and may vary depending on the specific state's licensing regulations. It is advisable to consult the relevant licensing agency or specific state regulations for more precise information.
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