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Fillable LIC 9214 - Application for Administrator Certification


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What is LIC 9214?

LIC 9214 is the form an applicant must submit to the Department in order to be certified as an administrator. This form must be accompanied by the appropriate fee and documentation, as specified on the form.

What is LIC 9214 used for?

Form LIC 9214 is the application for administrator certification. In addition, this form must be submitted by a previously certified administrator who did not renew their certificate within four years from the date of expiration.

How to fill out LIC 9214?

The application for administrator certification itself is not overly complicated, but there are a few key sections that applicants should pay close attention to. 

  1. In the "Applicant Information" section, for example, applicants will need to provide their full name, mailing address, email address, and phone number. They will also need to indicate whether they are applying for initial certification or renewal.
  2. In the "Certification Type" section, applicants will need to select which type of administrator certification they are applying for. There are three types of certification available. The type of certification an applicant select will determine the eligibility requirements that must be met in order to be approved for certification.
  3. Section a, "Checklist of Required Documentation," outlines all of the materials that must be submitted along with the LIC 9214 form in order for the application to be considered complete. These items include things like proof of completion of an administrator program, official transcripts, and a resume.

How to submit LIC 9214?

Once all of the required information and documentation has been gathered, the LIC 9214 initial application for administrator certification can be submitted either online or by mail. The mailing address is provided on the form. After the form has been received, processed, and approved, the applicant will be issued a certificate that is valid for four years.

The application must be accompanied by the appropriate fee and supporting documentation. Documentation may include but is not limited to, transcripts, course descriptions, and letters of recommendation.

Who should sign the LIC 9214?

Any person who wishes to be an administrator in a California long-term care facility must sign the application for administrator certification form LIC 9214.

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