TX HHS Form 2982. Personal History Statement

Form 2982, titled Personal History Statement, is a required document used by Texas Child Care Regulation (CCR) as part of the licensing process for child care and certain residential care operations. This form helps the state evaluate whether individuals responsible for operating or managing a child care program meet legal, professional, and safety standards.

The form focuses on personal background, education, work experience, prior licensing history, and disclosures related to criminal history or child welfare investigations. It plays a critical role in determining eligibility for a license.

When and Why This Form Is Required

Form 2982 must be completed during the application process for a child care license in Texas. It is used to assess the suitability of key individuals involved in the operation, particularly those with decision-making authority or direct responsibility for children.

The form is mandatory because Texas law requires Child Care Regulation to verify that individuals in leadership roles do not pose a risk to children and have appropriate experience and background.

Who Must Complete Form 2982

This form is not required for every employee. It must be completed by specific individuals depending on the type of operation.

• Sole proprietors of child care operations
• Business partners in a child care operation
• Directors, co-directors, or interim directors of licensed child care centers
• Sole proprietors or partners applying for a residential care license (unless they are licensed administrators)

Explanation of Each Section

Part I – Personal and Operation Information

This section identifies the individual completing the form and links them to a specific child care operation. It includes name, date of birth, contact information, Social Security number or Texas driver license, and details about the operation such as capacity and location.

Part II – Education and Employment Experience

This section documents the individual’s educational background, professional training, licenses, and employment history for the past 10 years. CCR uses this information to verify qualifications and relevant experience in child care, supervision, or program management.

Part III – Previous Permits

Applicants must disclose any past or current child care permits, including registrations, denials, revocations, probation, or bars from operating. This history helps CCR identify compliance patterns or past regulatory concerns.

Part IV – People in the Home

This section applies only to child care home operations. It lists all household members aged 14 or older who live in the home where care is provided, allowing CCR to conduct required background checks.

Part V – Child Abuse and Neglect History

Applicants must disclose whether they or household members have ever been investigated by child protective services, law enforcement, or child welfare agencies. This information is critical for child safety assessments.

Part VI – Criminal Charges and Convictions

This section requires disclosure of any felony or misdemeanor convictions, pending charges, or deferred adjudications involving the applicant or listed individuals. CCR evaluates this information under state suitability standards.

Part VII – Physical and Emotional Status

The applicant must confirm that they are physically and emotionally fit to act in a leadership role. For home-based care, this includes other household members whose condition could affect child safety.

Part VIII – Director Documentation

Directors or interim directors of licensed centers must attach supporting documents such as transcripts, training certificates, or credentials. Originals are reviewed and returned.

Part IX – Certification and Signature

This section confirms that all information provided is accurate and authorizes CCR to verify the details. False statements can result in denial or later revocation of a license.

Practical Tips for Completing the Form

• Answer all questions completely, even if the answer is “No.”
• Provide clear explanations for any “Yes” responses related to criminal history or investigations.
• List employment history in chronological order, starting with the most recent.
• Double-check names, dates, and addresses for consistency with other application documents.

Common Mistakes to Avoid

• Leaving sections blank instead of marking “No” or “Not applicable”
• Failing to disclose prior permits or investigations
• Providing incomplete employment history
• Forgetting to attach required supporting documentation

Real-Life Use Examples

• A new child care center director completes Form 2982 as part of the center’s initial license application.
• A sole proprietor opening a home-based child care program lists household members to comply with background screening rules.
• A partner in a child care business discloses prior licensing history from another Texas county.

Documents Commonly Attached to This Form

• Director certificates or credentials
• College transcripts or diplomas
• Training course certificates
• Professional licenses or certifications

Frequently Asked Questions

Is Form 2982 required for all child care staff?

No. It is required only for owners, partners, directors, co-directors, and certain residential care applicants.

Do household members need to complete this form?

No, but they must be listed in Part IV if the operation is home-based.

What happens if information is omitted or incorrect?

Incomplete or false information can delay processing or result in denial or revocation of the license.

Where should the completed form be sent?

The form must be mailed to the nearest Texas Child Care Regulation office.

Is prior criminal history an automatic disqualification?

No. CCR evaluates disclosures based on state rules, severity, and relevance to child safety.

Micro-FAQ

• Purpose: Evaluate personal suitability for child care licensing.
• Who files: Owners, partners, directors, and interim directors.
• When filed: With a child care or residential care license application.
• Attachments: Training, education, and credential documents.
• Submitted to: Texas Child Care Regulation.

Related Forms

• Child Care License Application (Texas)
• Criminal History and Background Check Forms
• Director Qualification Verification Forms

Form Details

• Form Name: Personal History Statement
• Form Number: 2982
• Region: Texas
• Issuing Authority: Texas Health and Human Services – Child Care Regulation
• Revision Date: December 2023