TX HHS Form 3649. Assisted Living Facility Background Disclosure Statement for Applicants for Employment

The TX HHS Form 3649, Assisted Living Facility Background Disclosure Statement for Applicants for Employment, is a crucial document that helps ensure the safety and well-being of residents in assisted living facilities. The form is used to gather information about job applicants' criminal history and residency status, allowing facilities to make informed hiring decisions.

The form requires facilities to complete Section 1 and provide it to any applicant who applies for employment at the facility. If an applicant has lived in another state within the past five years, the facility must conduct a name-based criminal history check in each state where the applicant previously resided. The form also includes sections for applicants to provide their personal information and disclose any relevant details about their background.

Key features of the form include the requirement for facilities to complete Section 1 and provide it to job applicants, as well as the need for facilities to conduct a name-based criminal history check if an applicant has lived in another state within the past five years. The form also emphasizes the importance of transparency and honesty on the part of applicants.

• The form is used by assisted living facilities to gather information about job applicants' criminal history and residency status.
• Facilities must complete Section 1 of the form and provide it to any applicant who applies for employment at the facility.
• If an applicant has lived in another state within the past five years, the facility must conduct a name-based criminal history check in each state where the applicant previously resided.