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Form #720

Application for Family Home License

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Application for Family Home License - Free Legal Form
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Application for family home license.

DO NOT WRITE IN THIS SPACE—AGENCY USE ONLY

DCFS Region/Site/Field

 

Responsible for License _________

Date Received _________

County No. _________

Date Entered _________

Supervising Agency No. _________

 

 

—. DCFS: Regional Office _________ Field Office _________

—. Licensed Child Welfare Agency

—. Licensed Day Care Agency

—. License Exempt Agency

—. Independent Home

Name _________

Address _________

Name _________

Address _________

PLEASE READ INSTRUCTIONS [OMITTED] ON THE BACK BEFORE COMPLETING THIS APPLICATION

APPLICATION FOR (Check One)

—. INITIAL LICENSE

—. RENEWAL OF LICENSE Number _________

—. REINSTATEMENT Number _________

—. APPLICANT PLEASE CHECK THE TYPE OF LICENSE FOR WHICH YOU ARE APPLYING (CHECK ONE ONLY)

—Foster Family Home—Day Care Home

Name of Applicants:

A. _________

Social Security No. _________

 

B. _________

Social Security No. _________

 

Address _________

Mailing

Address _________

Telephone ( )

ALL APPLICANTS PLEASE ANSWER THE QUESTIONS BELOW AND SIGN THE APPLICATION.

1. The Department frequently receives requests from businesses, organizations and local government jurisdictions for lists of family home licensees. If you wish to have your name excluded from these listings, check (3) here:—

2. Have you ever been convicted for other than a minor traffic violation?

—No —Yes If yes, explain: _________

3. Are you currently licensed for child care in _________? —No —Yes

If yes, give type of license(s) _________

Name on license(s) _________

Address on license _________

4. Have you ever been licensed for child care outside _________? —No.

—Yes License Number(s) _________

If yes, give type of license(s) _________

Name on license(s) _________

Address on license _________

5. If you are not currently licensed for child care, complete the questions below:

Have you ever applied for a child care license? —No —Yes

Was license issued? —No —Yes

If yes, give type of license _________

Name on license _________

Address on license _________

I (WE) the undersigned, representing the facility herein named, hereby apply for license to operate a child care facility under the Child Care Act of 1969 as amended. I (WE) declare that, I (WE):

I. Have received a copy of the standards, have read and are familiar with the standards for which license is sought.

II. Will be subject to investigation upon application in regard to meeting standards.

III. Will cooperate with the licensing agency through the study.

IV. Are aware that to operate a child care facility without a license or permit constitutes a Class A misdemeanor and that I (WE) may be prosecuted for such misconduct.

V. Will be subject to supervision in terms of conformance with minimum standards upon issuance of a license.

VI. Affirm that the information provided above is true. I (WE) understand that making materially false statements in order to obtain a license or permit constitutes a Class A misdemeanor and that I (WE) may be prosecuted for such misconduct.

SIGNATURE(S)

 

_________

_________

 


Page 1 Page 2 Page 3
 
Contributed by
Asian Investment Advisers		  
Name of Firm Asian Investment Advisers
Total Forms Contributed 61
 

See All Asian Investment Advisers's Forms
 

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Terms Of Use

Submissions to this site, including any legal or business forms, posts, responses to questions or other communications by contributors are not intended as and should not be construed as legal advice. You are strongly encouraged to consult competent legal council before engaging in any action based upon content contained on this site.

These downloadable forms are only for personal use. Retransmission, redistribution, or any other commercial use is prohibited. This includes reposting forms from this site to another site offering free legal or other document forms for download.

Please note that the donator may have included different usage terms regarding this form, and you agree to abide by these terms. It is highly recommended that you have a licensed attorney review any legal documents for which you are searching in order to make sure that your needs are being properly and completely satisfied.

Your use of this site constitutes your acceptance of our terms of use and your agreement to hold this site, its officers, employees and any contributors to this site harmless for any damage you might incur from your use of any submissions contained on this site. If you do not agree to the above terms, please do not proceed.

These forms are provided to assist business owners and others in understanding important points to consider in different transactions. They are offered with the understanding that no legal advice, accounting, or other professional service is being offered by these documents or on this website. Laws vary in the different states. Agreements acceptable in one state may not be enforced the same way under the laws of another state. Also, agreements should relate specifically to the particular facts of each situation. Therefore, it is important to consult legal counsel whenever utilizing these forms. The Forms are not a substitute for legal advice YourFreeLegalForms.com is not engaged in recommending or referring members on the site or making claims about the competence, character or qualifications of its participating members.
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Comments
submitted 10/25/2008
by DavidMarshall  
"When parents are not around or do the job badly, it is the responsibility of the state to look after any children. One option is the appointment of foster parents or other people to give the care. The states have the right to license people to operate a child care facility under the Child Care Act of 1969 and this form allows people to apply for a family home license. The state investiagtes to make sure that the individuals are licensed to provide this service and are generally suitable candidates. The state will also check out the home to make sure it is a safe and secure place in which to bring up children."
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