Applicant Verification for Employees
Consumer Directed Services (CDS)
To verify and document the applicant's qualifications and eligibility for employment by the employer for Consumer Directed Services (CDS).
This form also serves as the Consumer Directed Services Agency (CDSA) applicant verification form. All applicants must be verified by the CDSA before the CDS employer can hire the applicant.
To certify by signature of the employer and the applicant that the applicant:
- does meet qualifications and criteria for employment, or
- does not meet one or more qualifications and criteria for employment.
When to Prepare
The employer must complete this form with each applicant before the individual can be hired or before a former employee can be rehired by the employer.
Number of Copies
Original and two copies.
The employer keeps the original form in the employee's personnel file and sends a copy to the CDSA at the time the form is completed.
This form must be printed or downloaded through the Consumer Directed Services Handbook at: www.dads.state.tx.us/handbooks/cds/forms/index.asp
The employer must keep this form while in effect, plus five years after termination of employment or until all outstanding litigation, claims and audits are resolved.
Individual's Name — Enter the name of the individual.
Employer Name — Enter the name of the employer.
Applicant Name — Enter the name of the applicant.
Applicant Social Security No. — Enter the applicant's Social Security number.
The employer must verify that the applicant meets each criterion. The employer must enter a check mark in each box and, where applicable, enter information to verify a qualification. The employer must ensure the forms and/or copies of documentation to verify the criteria are valid and in the employee's personnel file.
Each qualification in this section must be met. The employer must verify documentation to support the qualification by placing a check mark for each statement met.
Required forms must be completed and retained in the employee's personnel file by the employer. Copies of forms are sent to the CDSA.
The applicant must be at least 18 years of age. The applicant's age must be verified using the applicant's driver's license, government identification card, birth certificate, passport, certificate of U.S. citizenship, temporary resident card or other document used to complete Form I-9, Employment Eligibility Verification, that provides a date of birth.
For the Community Living Assistance and Support Services (CLASS) and Deaf-Blind with Multiple Disabilities (DBMB) programs, habitation and intervener employees must have current CPR Certification.
CDSA Certification and Acknowledgment:
The CDSA enters a check mark to indicate that the applicant either does or does not meet each qualification for employment.
Employer Signature/Date — The employer signs and dates the form.
CDSA Signature/Date — The CDSA must sign and date this form to certify that the applicant either qualified for employment or does not. Once this form is signed by the CDSA and sent back to the employer, the employer may hire the applicant.