Form LIC 9052 is the one-page Employee Rights notice that every licensed California child care facility must give to each employee at hire. Published by the California Department of Social Services, it explains the state’s whistleblower protections for child care workers and includes a detachable acknowledgment the employee signs and returns for the personnel file.1California Department of Social Services. LIC 9052 – Notice Employee Rights The requirement traces to Health and Safety Code sections 1596.881 and 1596.882, with the paperwork mechanics set out in Title 22 of the California Code of Regulations.2California Legislative Information. California Health and Safety Code HSC 1596.881
Where to Download the Form
The current version is LIC 9052 (1/22). You’ll find it on the Department of Social Services forms page under the I–L alphabetical list, or you can go straight to the PDF at cdss.ca.gov.3California Department of Social Services. Forms and Publications I-L It’s free. Print one for every new hire.
What the Notice Tells the Employee
The top portion of the form, which the employee keeps, lists four activities the employer cannot punish:1California Department of Social Services. LIC 9052 – Notice Employee Rights
- Filing an oral or written complaint about the employer’s violation of a licensing law or other law — covering child abuse, staff-to-child ratios, and transportation rules — with the Department of Social Services, another enforcement agency, or the employer itself.
- Starting or causing any legal or administrative proceeding related to such a violation.
- Testifying or planning to testify in such a proceeding.
- Refusing to perform work that violates a licensing law or regulation, after telling the employer about the violation.
Prohibited retaliation includes firing, demoting, suspending, threatening any of those actions, or discriminating in any other way tied to the protected activity.2California Legislative Information. California Health and Safety Code HSC 1596.881 The form also tells employees how to pursue a retaliation claim through the Division of Labor Standards Enforcement, with a 45-day deadline to raise the issue with the employer and a 90-day deadline to file with DLSE.4California Legislative Information. California Health and Safety Code HSC 1596.882
How to Hand Out and Complete the Form
Give the form to the employee at the start of employment. The notice at the top stays with the worker. The acknowledgment at the bottom detaches and comes back to you.1California Department of Social Services. LIC 9052 – Notice Employee Rights
The acknowledgment has four fields:
- Name of the facility, written out as it appears on your state license.
- Employee signature confirming receipt.
- Date the employee received the form.
- Printed names of both the employer and the employee.
Build the handoff into your onboarding packet so the signature happens before the first shift, alongside fingerprinting, the health screening, and tuberculosis clearance.
If the Employee Won’t Sign
A refusal doesn’t release you from the distribution requirement. Make a dated note in the employee’s personnel record stating that the form was offered and the employee declined to sign, and keep that note on file.5Cornell Law Institute. California Code of Regulations 22 CCR 101216 – Personnel Requirements The obligation is to offer the notice and document what happened.
Where the Signed Slip Goes
File the signed acknowledgment in the employee’s personnel record. Title 22, section 101217 lists LIC 9052 as a required item in every personnel file, together with criminal record clearance documentation, tuberculosis results, health screenings, and proof of qualifications.6New York Codes, Rules and Regulations. California Code of Regulations 22 CCR 101217 – Personnel Records Keep the record for the duration of employment; because the file must also document the employee’s termination date, it needs to persist past the last day of work.
What a Missing Form Costs You
A missing LIC 9052 acknowledgment is the kind of gap licensing evaluators flag on site visits, and it can be written up as a deficiency. Under 22 CCR section 101195, an uncorrected serious deficiency carries a penalty of $50 per day, up to $150 per day per violation.7Cornell Law Institute. California Code of Regulations 22 CCR 101195 – Penalties A repeat violation of the same regulation within 12 months triggers an immediate $150 on day one, then $50 per day until corrected. A third offense inside another 12-month window pushes the ongoing daily penalty to $150.
The Department of Social Services can also pursue suspension or revocation of a license for uncorrected violations.8California Department of Social Services. LIC 421 – Civil Penalty Assessment A single missing acknowledgment is unlikely to trigger that outcome on its own, but it adds to a pattern when combined with other documentation gaps.
Not the Same as the Parents’ Rights Notice
LIC 9052 covers employees only. The parents’ rights notifications required under Health and Safety Code section 1596.857 and 22 CCR section 101218.1 are separate obligations handled through different documents, including the PUB 393 Parents’ Rights poster.9California Legislative Information. California Health and Safety Code HSC 1596.857 Both apply at the same time; neither substitutes for the other.