Get the free Use this form to apply for a duplicate personnel license or certificate, or facility...
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You can view the Fee Schedule on the LFS website at https //www. cdph. ca.gov/Programs/OSPHLD/LFS/CDPH 20Document 20Library/A-License-FeeSchedules. Mandatory information is used to properly identify an applicant and to determine an individual s eligibility for licensure. Pdf Name first middle last or Facility Name Address City License/Certificate/Registration number Type of license requested Signature Print Name State ZIP Number of duplicates Amount remitted Date NOTE Effective January 1 1997...
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