GCC-03

Employment History Check Please provide the DHS 959A Self-Certification of Employment and DHS 959 Employment History Clearance form(s) for XXXXX.<br/> <br/> ---------------------------------<br/> <b>Please also provide the DHS 974A Notification of Changes form with XXXXX hire date.</b><br/> ---------------------------------<br/> <br/> Employment History Instructions:<br/> <br/> Required individuals shall complete the form DHS 959A "Self Certification of Employment" and list the places of employment within the past three (3) years including periods of unemployment, self-employment, and periods of school attendance. For every place of employment listed, complete and sign Part I of the DHS 959 "Employment History Clearance Form" (EHC) and have the former and/or current employer complete and sign part II.<br/> <br/> Please complete the following information on the form DHS 959A: Date EHC mailed and Date EHC returned. Keep copies of all forms mailed out to former employers. If EHC forms are not returned after the first try, mail out the copy again and log the 2nd date mailed. If forms are not returned after the second try, we will accept the self-certification.<br/> <br/> <b>Please visit the following for the required forms:</b><br/> http://humanservices.hawaii.gov/bessd/child-care-program/child-care-licensing/child-care-center-Licensing-forms/<br/>

17-892.2-3 · Correction status not published

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