Background Check - Promise Kids Learning Academy

Step 1 of 2

50%

CHILD CARE LICENSING REQUEST FOR BACKGROUND CHECK
Purpose: This form may be used to request background checks required by Texas Administrative Code (TAC) §745.615. You can also submit background check requests through HHSC’s Child Care Provider website. See the chart below for instructions based on operation type for submitting background check requests.

IF	THEN
You are applying for a permit	You must send your background check request form along with your application to your local licensing office.
Your operation is a licensed child-care center, school-age program, before- or after-school program, or residential care provider	Your operation must submit background check requests via HHSC’s Child Care Provider Page.
Your operation is a licensed child-care home, registered child-care home, or listed family home	Your operation may submit background check requests via HHSC’s Child Care Provider page, fax the background check form to 512-339-5871, or mail the background check form to: HHSC, Centralized Background Check Unit, P.O. Box 149030, Mail Code: 121-7, Austin, TX 78714-9030.
You are an exempt operation submitting background check requests only	You may submit your background check requests to the following mailbox: CBCUExemptBGC@dfps.state.tx.us

Directions: Complete the following information for each person required to have a background check. Additional forms may be downloaded from the DFPS website at http://www.dfps.state.tx.us/Child_Care/Information_for_Providers/cclforms.asp.

INDIVIDUAL'S IDENTIFYING INFORMATION
Name*
First Middle Last
Other Name
First Middle Last
List any other names the individual uses or has used in the past, including married and maiden names, below. If you do not provide every name that the individual has used, you may receive inaccurate results:
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Date of Birth:*
Gender*
- Male
- Female
List any other city in Texas where the person has been a resident and any addresses, including county, where the person has lived outside of Texas in the previous five years:
Ethnicity*
- Hispanic
- Non-Hispanic
(must accompany race):
Race:
- White
- Black
- Asian
- American Indian/Alaskan Native
- Native Hawaiian/Pacific Islander
Social Security Number:*

Photo ID Type:*

Driver License: Number	State

Today's Date*

HOURS OF OPERATION:
Monday – Friday: 5:30 AM – 12 AM
Saturday: 8:00 AM – 2 PM
Sunday: CLOSED

mail@pklearningacademy.com

832-379-3334

Promise Kids Learning Academy promotes and nurtures the intellectual, cultural, and physical development of our students through direct hands-on experiences, while collaborating with our parents. Our mission is to see that each child shines in his or her own way.

Join our Classes now

Site Designed by No Regret Media

Step 1 of 2

CHILD CARE LICENSING REQUEST FOR BACKGROUND CHECK

INDIVIDUAL'S IDENTIFYING INFORMATION

About

Classes

Latest News

OPEN HOUSE

Powered By