STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY PARENT/LEGAL GUARDIAN SIGNATURE: LIC 9224 (8/08) DATE DOCUMENTS RECEIVED: ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS I, as the parent/legal guardian of , currently attending or newly enrolled at. The California notary acknowledgement forms are certificates verifying that a notary public has confirmed the identity of a person who signed a legal document.An individual seeking acknowledgement must appear before the notary public and present satisfactory. This form complies with current California statutes regarding notary wording and, if needed, should be completed and attached to the document. Acknowledgments from other states may be completed for documents being sent to that state so long as the wording does not require the California notary to violate California notary.
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Employer Pull Notice Program Forms
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After completing the required form, please mail it to the address on the form. The department cannot accept completed forms submitted by e-mail at this time.
Call (916) 657-6346 for assistance regarding any forms or for general questions. Please call between the hours of 8 a.m. and 5 p.m. Monday, Tuesday, Thursday and Friday, between 9:15 a.m. and 5 p.m. on Wednesday.
- Employer Pull Notice Program Requirements (PDF) (INF 1107)
- Application for Employer Pull Notice Account (PDF) (INF 1104)
More information about the INF 1104 form
- Commercial Employer Pull Notice Enrollment or Deletion of Drivers form and Instructions (PDF) (INF 1100)
More information about the INF 1100 form
New California Acknowledgement Form
- Authorization for Release of Driver Record Information (PDF) (INF 1101)
More information about the INF 1101 form
- Commercial or Government Employer Pull Notice Enrollment of Out-of-State Licensed Drivers form and Instructions (PDF) (INF 1102)
More information about the INF 1102 form
- Commercial Employer Pull Notice Requester Account Notice of Change form and Instructions (PDF) (INF 4)
More information about the INF 4 form
- Request for Closure of Employer Pull Notice Account form and Instructions (PDF) (INF 1112)
- Employer's Report of Medical Exam Failure/Request for Reexamination of Driver (PDF) DS524
More information about the DS524 form
- Government Employer Pull Notice (PDF) (INF 1103)
More information about the INF 1103 form
- Information Security Statement (PDF) (INF 1128)
More information about the INF 1128 form
- Request for Driver License/Identification Card Status and Record Information (PDF) (INF 1119)
More information about the INF 1119 form
- Employer Pull Notice Agent Authorization form (PDF) (INF 2110)
More information about the INF 2110 form
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Employer Pull Notice