Home Care Aide Registry Live Scan Form

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Home care aide registry live scan form. Home care aide application process. Live scan transaction completed by. The live scan operator will complete section 8.

Live scan transaction completed by. One copy will be retained by the operator and the other you may retain for your records. This section will be completed by the live scan operator.

Name of operator date. Lic 9163 12 15 page 4 of 4. On or before expiration of registration a home care aide can request renewal of their registration and pay renewal fees online.

Live scan transaction completed by. State of california department of justice bcia 8016 page 1 of 4 rev. Take two copies of this form with you the day you are fingerprinted.

One copy will be retained by the operator and the other you may retain for your records. The live scan operator will complete section 8. A home care aide can submit and pay for an online application to be listed on the home care aide registry.

To become listed on the home care aide registry you must complete and mail the attached application hcs 100 the criminal record statement lic 508 and a check or money order to the address listed on the top of the application form. Ati number amount collected billed. This section will be completed by the live scan operator.