TX HHS Form 3233. Licensed Chemical Dependency Counselor Program Request for Criminal History Evaluation

The TX HHS Form 3233, "Licensed Chemical Dependency Counselor Program Request for Criminal History Evaluation," is a crucial document for individuals seeking to participate in the Licensed Chemical Dependency Counselor (LCDC) program. This form helps solve the problem of verifying an applicant's criminal history and ensuring that all relevant information is disclosed.

The form consists of four sections, each designed to gather specific information about the applicant's criminal history. Section 1 requests personal information, including legal name, date of birth, and social security number. Section 2 requires a list of all convictions, excluding minor traffic offenses, with attached copies of indictments and judgments. Section 3 focuses on deferred adjudications, while Section 4 covers arrests that did not result in conviction or deferred adjudication.

It is essential to complete this form accurately and thoroughly, as failure to disclose all criminal history can lead to the program invalidating the evaluation letter. The applicant should use this form when seeking admission to the LCDC program and must provide the required information and supporting documentation to ensure a successful application.