TX HHS Form 2912. Pre-Employment Affidavit for Applicants for Employment at Certain Child Care Operations

Form 2912, titled Pre-Employment Affidavit for Applicants for Employment at Certain Child Care Operations, is a mandatory disclosure document used in Texas for individuals seeking employment in regulated child care settings. Its purpose is to ensure transparency and protect minors by requiring applicants to disclose whether they have ever been charged with, adjudicated for, or convicted of having an inappropriate relationship with a minor.

This affidavit is completed during the hiring process and submitted directly to the prospective employer. It is governed by Texas Human Resources Code Section 42.0563 and completed under penalty of perjury.

Purpose and When This Form Is Required

Form 2912 is required whenever an individual applies for a position that involves contact with children in certain licensed or registered child care operations in Texas. Employers are legally obligated to collect this affidavit before finalizing employment.

The form is required for applicants seeking employment at:

• General Residential Operations
• Licensed Child Care Centers
• School-Age Programs
• Before and After-School Programs
• Licensed Child Care Homes
• Registered Child Care Homes

If an applicant is not seeking employment in one of these regulated settings, this specific affidavit is generally not required.

Who Must Complete the Affidavit

The affidavit must be completed by the job applicant personally. It cannot be completed by an employer, representative, or third party. Each applicant must provide truthful and complete information based on their own legal history.

Legal and Regulatory Background

This form exists to satisfy statutory requirements under Texas law. Texas Human Resources Code Section 42.0563 mandates that child care providers obtain a sworn statement from applicants regarding past offenses involving minors. The affidavit is executed in accordance with Texas Civil Practice and Remedies Code Section 132.001, which allows unsworn declarations to be made under penalty of perjury.

The affidavit does not replace criminal background checks but serves as an additional compliance and disclosure tool for employers.

Explanation of Key Sections

Applicant Disclosure Statement

The applicant must indicate whether they have ever been charged with, adjudicated for, or convicted of having an inappropriate relationship with a minor. This includes cases that occurred in the past, even if they did not result in a conviction.

Details of Charges, Adjudications, or Convictions

If the applicant answers “yes,” they must list all relevant facts for each charge, adjudication, or conviction. This includes details such as:

• Description of the incident
• Law enforcement agency involved
• Date of the charge, adjudication, or conviction
• Whether the charge was determined to be true or false

If there is nothing to disclose, the applicant must explicitly write “none.”

Declaration of Applicant

The final section requires the applicant to declare under penalty of perjury that all information provided is true and complete. This declaration gives the affidavit legal force.

Documents That May Be Attached

Applicants may attach supporting documentation if relevant, especially when a listed charge was determined to be false. Common attachments include:

• Police reports
• Certified court documents
• Additional pages explaining the facts of the case

Attachments are optional but can help clarify the applicant’s disclosure.

Practical Tips for Completing Form 2912

• Read each question carefully and answer honestly.
• Do not omit past incidents, even if they are old or were dismissed.
• If there is nothing to disclose, clearly write “none” rather than leaving sections blank.
• Attach documentation when it helps explain the outcome of a charge.
• Ensure all required personal information is legible and complete.

Common Mistakes to Avoid

• Failing to disclose past charges that did not result in conviction.
• Leaving required sections blank instead of writing “none.”
• Providing vague or incomplete descriptions of incidents.
• Assuming notarization is required (it is not).

Real-Life Examples Where This Form Is Used

• An applicant applying for a teaching assistant position at a licensed child care center is asked to complete Form 2912 during onboarding.
• A caregiver seeking employment at a registered child care home must submit this affidavit before starting work.
• A school-age program requests Form 2912 from a new staff member as part of regulatory compliance.

Frequently Asked Questions

Does Form 2912 require notarization?

No. The affidavit is completed as an unsworn declaration under penalty of perjury and does not require notarization.

What happens if I fail to disclose required information?

Failure to disclose information required by the affidavit is grounds for termination of employment.

Do dismissed or false charges need to be listed?

Yes. Charges must be listed even if they were later determined to be false, with an explanation of the outcome.

Is this form a background check?

No. It is a disclosure affidavit and does not replace fingerprinting or criminal background checks.

Who keeps the completed affidavit?

The completed form is submitted to and retained by the employing entity.

Can I attach extra pages?

Yes. Applicants may attach additional pages or documents if more space is needed to explain relevant facts.

Related Forms and Documents

• Child Care Background Check Request Forms
• Employment Eligibility Verification Forms
• Texas Child Care Licensing Compliance Forms

Form Details

• Form Name: Pre-Employment Affidavit for Applicants for Employment at Certain Child Care Operations
• Form Number: 2912
• State: Texas
• Issued By: Texas Health and Human Services Commission
• Revision Date: September 2023