TX HHS Form 8622. Consent for Criminal History Check

The TX HHS Form 8622, Consent for Criminal History Check, is a crucial document that enables individuals to consent to criminal history checks as part of the State Long-Term Care Ombudsman Program. This form is essential for all representatives of the Office of the State Long-Term Care Ombudsman, including volunteers and staff, who wish to participate in the program.

This form requires applicants to provide personal information, including their names ever used, email address, phone number, and physical address. Additionally, applicants must disclose any prior convictions, pending legal charges, and current or previous related licenses or certifications. The form also includes a section for the applicant's printed name, signature, and date.

The TX HHS Form 8622 should be used by all representatives of the Office of the State Long-Term Care Ombudsman who wish to participate in the program. This includes volunteers and staff who must complete a criminal history check and have no barring criminal convictions. The form is designed to ensure that applicants are thoroughly vetted and meet the necessary requirements to serve as certified volunteer or staff ombudsmen.