Employer Certification Regarding High School Diploma, Ged Or Equivalent Documents
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1Employer Certification Regarding High School Diploma, GED or Equivalent Documents
CLASS and MDCP PROGRAMS ONLY
Participant Name
)
(Client
Applicant Name
(Employee)
I
certify that I am
The participant
The legally authorized representative
The designated representative
I certify that I have copy of the applicant's
(Employee)
High school diploma
GED
The applicant did not have either of these documents
If the above applicant did not have a copy of his/her high school diploma or GED, I have obtained the following:
• Documentation of a proficiency evaluation of the employee's experience and competence to perform job tasks, including
an ability to provide the services needed by the individual, as demonstrated through written competency-based
assessment; and
• At least three personal references from people not related by blood that evidence the person's ability to provide a safe
and healthy environment for the individual
I understand that I must keep these document in my employee's file and produce them at the request of my case manager/
service coordinator, FMSA, and my DADS or HHSC employee, including utilization review nurse.
Employer's Name
Date
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