Get Hhsc Dps Tx Online Form

The Hhsc Dps Tx online form is a crucial document for individuals needing approval to take the competency evaluation program in Texas. This guide will provide you with clear instructions on how to effectively fill out the form online, ensuring a smooth application process.

Follow the steps to successfully complete the Hhsc Dps Tx online form.

1. Use the 'Get Form' button to obtain the Hhsc Dps Tx online form and open it for editing.
2. Begin by completing Item A, which requires you to enter your name in the format of Last, First, Middle.
3. Proceed to Item B and fill in your maiden name, if applicable. If you do not have a maiden name, you may leave this section blank.
4. In Item C, provide any other surnames you may have used in the past.
5. Complete Item D by entering your Social Security number.
6. For Item E, input your date of birth in the format mm/dd/yyyy.
7. Fill out Item F with your complete address, including Street, City, State, and ZIP code.
8. In Items G and H, provide both your home and daytime telephone numbers, including area codes.
9. If you are employed at a facility, indicate the name of the facility in Item I.
10. For Item J, provide the address of your place of employment.
11. Complete Item K by stating the name of your training program.
12. Item L requires the address of your training program. Fill in the address details.
13. In Item M, specify the dates of your training program in the format mm/dd/yyyy, entering both 'From' and 'To' dates.
14. Answer Item N by indicating if you are on the Nurse Aide Registry in another state with options of Yes, No, or Unknown.
15. If you answered Yes in Item N, specify the state(s) in Item O.
16. Sign the form in Item P to certify that the information you provided is accurate.
17. Finally, fill out Item Q by entering today's date in the mm/dd/yyyy format.
18. Ensure to attach the required documents, including proof of successful completion of a Nurse Aide Training Program approved in another state and any necessary name change documents.
19. Once all items are completed, save your changes and choose to download, print, or share the completed form as needed.

Complete your Hhsc Dps Tx online form today and ensure you submit all necessary documentation for a smooth application process.