TX HHS Form 2985. Affidavit for Applicants for Employment with a Licensed Operation or Registered Child-Care Home

This affidavit is a mandatory disclosure form required from anyone seeking temporary or permanent employment in a licensed child care facility, child-placing agency, or registered child-care home. Because these roles involve direct contact with children, the state requires applicants to formally confirm—under penalty of perjury—that they have no history of criminal conduct or child-related offenses that would compromise child safety.

Purpose of Form 2985

Form 2985 serves as a sworn statement verifying that the applicant has not engaged in a wide range of criminal or child-related misconduct. Licensing authorities use this affidavit to protect minors from individuals who may pose a risk and to ensure child-care providers comply with state safety regulations.

Submitting false information on this form carries significant legal consequences, including termination, disqualification from employment, and potential criminal penalties.

Who Must Complete This Form

You must complete Form 2985 if:

• You are applying for any role—temporary or permanent—that involves interaction with children.
• You are applying to a licensed child care facility, licensed child placing agency, or registered child-care home.
• Your work duties allow you access, direct care responsibilities, or unsupervised time with minors.

Individuals who perform only administrative or remote work without potential for child interaction may not be required to complete this affidavit, but the employer makes the final determination.

Legal Background and State Requirements

This affidavit exists because state child-care regulations require facilities to screen employees for any past conduct posing risk to children. Many of the listed offenses permanently disqualify a person from employment in child-care settings. The state treats these disclosures as part of its child protection framework, alongside background checks and fingerprinting.

The affidavit is not a substitute for a background check—it supplements it. If the information on this form contradicts official criminal records, the applicant may face legal action.

Explanation of Each Major Section of the Form

Section: Personal Sworn Statement

Here, the applicant swears under oath that they have never committed, admitted to, been charged with, or been involved in any legal or civil action relating to specific offenses. This includes incidents as a juvenile. The fact that the form covers “any judgment,” “any settlement,” and “any substantiated report” means even non-criminal matters must be disclosed.

Section: List of Disqualifying Offenses

The form lists a broad range of criminal and civil offenses. These include:

• Any felony
• Sexual offenses (rape, sexual assault, misconduct with a minor)
• Physical or emotional abuse of a minor
• Child exploitation or pornography
• Violent crimes involving minors
• Custody interference, kidnapping, or child abduction
• Court-ordered restrictions on contact with children

Applicants must confirm they have never engaged in any conduct within these categories, even if no conviction occurred.

Section: Exceptions

If an applicant has any incident that fits the description—even an arrest without conviction—they must list:

• incident details,
• location,
• description,
• date.

Applicants with no history must write “None.” Leaving this section blank is considered a red flag by employers.

Section: Signature and Notary

This affidavit must be signed in front of a notary. The notarial officer verifies your identity and confirms that you swore (or affirmed) that the information is truthful. An unsigned or un-notarized affidavit is considered invalid.

Common Mistakes to Avoid

• Leaving the “Exceptions” section empty instead of writing “None.” Employers treat this as incomplete disclosure.
• Assuming juvenile records don't matter. This form explicitly requires disclosing conduct as a juvenile.
• Failing to disclose dismissed charges. Even if dismissed, you must report them if they relate to the listed conduct.
• Using unclear descriptions. If you must report an incident, describe it plainly and factually.
• Signing without a notary. The form is invalid without notarization.

Practical Tips for Filling Out Form 2985

• Have a government-issued ID ready for notarization.
• If unsure whether an incident qualifies, disclose it—facilities prefer transparency.
• Prepare dates and locations in advance to avoid delays.
• Do not use abbreviations or vague descriptions.
• Double-check that the signature date matches the notary date.

Examples of When This Form Is Required

• A teacher’s aide applicant at a licensed preschool is asked to complete the affidavit before orientation.
• A part-time caregiver seeking weekend work in a child-care home must submit the affidavit even for non-full-time roles.
• A transportation driver who occasionally supervises children during transfers is required to complete the form.
• A volunteer coordinator at a children’s agency completes the affidavit because the role involves screening volunteers who work with minors.

Documents You May Need to Attach or Provide

• Government-issued photo ID for notarization
• Any court records related to disclosed incidents
• Police reports, if relevant
• Prior employment records if termination was related to child safety

FAQ

• Do I need to submit this form if I have never been arrested?
  Yes. All applicants must complete the affidavit regardless of their history.
• Is notarization mandatory?
  Yes. The affidavit is invalid without a notary’s signature and seal.
• What if my incident was expunged?
  You should still disclose it if it relates to the categories listed in the form.
• Will listing an old misdemeanor automatically disqualify me?
  Not always. The employer evaluates each case individually unless the offense is a mandatory disqualification.
• Can the employer verify the information?
  Yes. The affidavit supplements a full background check.
• What happens if I refuse to sign?
  The facility has “good cause” to deny employment.
• Can juveniles be disqualified?
  Yes. Conduct as a juvenile counts.

Micro-FAQ (Short Answers for Quick Reference)

• What is the purpose? To confirm an applicant has no disqualifying history involving children or serious crimes.
• Who must file? Anyone applying for work involving child interaction at a licensed facility.
• Is it legally required? Yes, under state child-care licensing rules.
• Notary required? Yes.
• What if I have nothing to report? Write “None.”
• Where is it submitted? To the child-care facility or agency hiring you.
• Does it affect background checks? It supplements but does not replace them.
• What if I lie? Possible termination and legal penalties.
• Do juvenile offenses count? Yes.
• Are dismissed charges included? Yes, if related to listed conduct.

Related Forms

• Background Check Request for Child-Care Employees
• Child-Care Licensing Personal History Statement
• Request for Criminal History Evaluation

Form Details

• Form Name: Affidavit for Applicants for Employment with a Licensed Operation or Registered Child-Care Home
• Form Number: 2985
• Edition Date: April 2018 (04-2018-E)
• Jurisdiction: State-regulated child-care licensing authority