Form 2947 Child Care Center Personnel Information Record
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1CHILD CARE CENTER
Texas Dept of Family
Form 2947
and Protective Services
January 2005
PERSONNEL INFORMATION RECORD
“Texas law gives you the right to know what information is collected about you by means of a form you submit to a
state government agency. You can receive and review this information, and request that incorrect information about
you be corrected by contacting your licensing representative.”
NAME:
ADDRESS:
PHONE #:
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DATE OF BIRTH:
DATE OF EMPLOYMENT:
DATE CHC SENT TO DFPS:
T.B. TEST DATE:
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GRADUATED?
GRADUATION DATE / GED
NAME OF HIGH SCHOOL:
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-
Yes
No
COLLEGE:
DEGREE:
CAREER PROGRAM (if applicable.):
INSTRUCTOR:
WORK SCHEDULE:
ATTENDANCE MAINTAINED
PREVIOUS EXP/TRAINING
WHERE AND HOW LONG
HOURS:
DAYS:
S
T
ign in log
ime sheet
CPR
First Aid Training
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-
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-
Exp.Date:
Exp.Date:
PRE-SERVICE TRAINING For Caregivers only
Check all that apply:
Staff with previous child care experience or training.
(DOES NOT REQUIRE 8 HRS OF PRE-SERVICE), OR
Staff without previous child care experience or training. Before being counted in the child/caregiver ratio, I received 8 hours of pre-
service training in the following areas:
Developmental stages of children.
Age-appropriate activities for children.
Positive guidance and discipline of children.
Fostering children’s self-esteem.
Supervision and Safety practices in the care of children.
Positive interaction with children.
Preventing the spread of communicable diseases.
Staff will not be working with children younger than 24 months.
(DOES NOT REQUIRE THE TRAINING LISTED BELOW), OR
Staff will be working with children younger than 24 months. Before being given counted in the child/caregiver ratio for a group of
children younger than 24 months of age, I received one hour of pre-service training in:
Recognizing and preventing shaken baby syndrome and sudden infant death syndrome; and
Understanding early childhood brain development.
Employee Signature
Date
Trainer Signature
Date
EMPLOYEE AND VOLUNTEER ORIENTATION
In addition to being oriented in the understanding of children and in job expectations, I have been oriented in:
An overview of the minimum standards for child care centers.
The Center's operational policies, including discipline, guidance, and the release of children.
The use and location of fire extinguishers and first aid equipment.
The procedures to follow in handling emergencies, including fire, explosion, tornado, toxic fumes, volatile persons, and severe
injury or illness of a child or adult.
An overview of symptoms of child abuse, neglect, and sexual abuse and the responsibility for reporting these.
I have received a copy of the child-care center’s operational policies.
I have received a copy of the child-care center’s written personnel policies including my job, job responsibilities, and requirements.
Employee Signature
Date
Trainer Signature
Date
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