*Required* - Please be sure to complete all fields with an asterisk (*) symbol.
Texas Health & Human Services requires submittal of Pre-Employment Affidavit form 2912 in order to be considered for employment at certain childcare operations. Please right-click on the button below and use the "Save link as" command to download the file to your desktop. Afterwards, click on the link to the Health & Human Services website for directions on opening the form. Once the form has been completed, send it via email to email@example.com.
*If you have any questions or problems, you can contact Heather Mahan at the email link above or call 806-747-3187.
*Required* - Include one (1) relative and three (3) non-related references.
*Required* - You must account for the last five (5) years of employment and include the name of your employer, not just the name of your supervisor. Location and phone number of employer must also be included for each entry.
Start with present or last job.
I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. According to Section 1100.3 Appendix V, of Texas Minimum Standard of Child Placing Agencies; “No one who has been convicted within the preceding ten years of any felony classified as an offense against the person or family, or of public indecency or of violation of the Texas Controlled Substances Act, or any misdemeanor classified as an offense against the person or family or a public indecency, may serve as a foster parent or as an employee in an agency home unless the Director of Licensing has ruled that proof of rehabilitation has been established”. In order for the Texas Boys Ranch to meet this requirement, will you please sign the following statement? “I have not been convicted within the preceding ten years of any felony or misdemeanor as classified in the above statement." In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.
Empowering Children - Giving Hope.
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