Who fills out an LIC 508?
HCS 281 says one form per applicant. That means: each individual applicant, each partner in a partnership, the CEO of a corporation, each person who owns 10% or more of a corporation or LLC, and the manager of a manager-managed LLC.
This is the same list as the HCS 215. HCS 281 does not list designees here. Our tracker below still asks for one from each designee. Designees must pass the CDSS background check too.
What the form asks
- Have you ever been convicted of a crime in California?
- Have you ever been convicted in another state, a federal court, the military, or outside the U.S.?
A conviction means a guilty plea, a no contest plea, or a guilty verdict.
You must say "yes" for every conviction. This includes old ones, misdemeanors, and drunk or reckless driving. It also includes cases that were later dismissed under Penal Code §1203.4(a). You do not need to list:- Some marijuana offenses covered by HSC §§11361.5 and 11361.7.
- Convictions dismissed under Penal Code §1203.49 because you were a victim of human trafficking.
Signing
Sign and date the form. HCS 281 accepts original signatures, photocopies of them, or verified e-signatures.
Moved? The LIC 508 says to send your new address to the Caregiver Background Check Bureau within 10 days.This tool does not give legal advice about what may block a license.
