California Code, Health and Safety Code - HSC § 26223

(a) The name, residence, date of birth, and driver's license number, including state or country of origin, of the applicant.

(b) The name and address of the employer or business of the applicant.

(c) The date of the application.

(d) The education and experience qualifications of the applicant.

(e) The action taken by the board regarding the application and the date of the action.

(f) The serial number of a certificate of registration issued to the applicant.

(g) Any other information required by board rule.