LIC 9052 is California’s Notice: Employee Rights form for child care employees. Download the official PDF directly from the California Department of Social Services. No paid PDF service or Daycare Compliance account is required.
Open the official LIC 9052 PDF ↗
The CDSS forms directory lists revision 1/22 as of our September 11, 2026 check. A search result labeled with a newer year is not evidence of a newer official form. Use the version linked by CDSS.
What is the form for?
LIC 9052 explains employees’ rights concerning complaints about licensing violations and related protections. Its instructions reference California Health and Safety Code sections 1596.881 and 1596.882. The official notice contains the full terms and procedures; read it in full rather than relying on this recordkeeping guide.
Who receives and signs it?
The form instructs the licensee to give it to the employee at employment, have the employee complete the detachable acknowledgment, and retain the signed acknowledgment in the employee’s file. The acknowledgment includes employee, employer, and facility names, plus the employee’s signature and date.
A practical acknowledgment checklist
| Step | What to record |
|---|---|
| Get the official document | Record the source link and revision you used. |
| Provide the notice | Include it in your onboarding workflow so it is easy to locate. |
| Review the acknowledgment | Check the returned record for the requested names, signature, and date. |
| File and index it | Record its location in the restricted personnel file. |
| Resolve missing items | Assign an owner and follow-up date until the record has been reviewed. |
Does LIC 9052 have an annual expiration date?
The reviewed form’s instructions concern acknowledgment at employment and do not assign an annual renewal interval. Do not invent an expiration date merely because your tracker has a date field. Keep any internal review date distinct, and check with your licensing authority about updates or circumstances affecting your program.
If the PDF does not open
Try the CDSS forms-directory link above and locate LIC 9052. You can save the official PDF and open it in your PDF reader. Keep its notice and acknowledgment intact. This site links to CDSS instead of maintaining a competing copy that could become outdated.
Keep onboarding records together
Use a staff-file index to distinguish a missing acknowledgment from a record that has arrived but still needs review. An internal task can say “acknowledgment missing” without exposing the underlying personnel record.
Continue with our California inspection paperwork guide or free binder structure and tracker. The staff records workspace can help request and organize missing documents. The official form remains free regardless of whether you subscribe.