TCP Employee Clearance Submission Sheet:

FY 24/25 DHS Contracts

Please utilize this form to submit the required clearances for each employee's clearance level as included on your program's Staffing List (905) and TCP Staffing/Clearance Identification Sheet.


Note: An updated 905 and TCP Staffing/Clearance Identification Sheet must be submitted to reflect all staff changes.

 

Provider/Contract Information

 

Please include the name of your organization.

 

Please include your program's full name as stated in your contract.

 

Please include your correct, FY 24 contract number.

 

Please submit the email(s) of the point-of-contact(s) who will update clearances on a need-be basis.

 

Employee Information

 
 
 

Active - Employed with agency and listed on Staffing List (905) and TCP Staffing/Clearance Identification Sheet

Inactive - No longer employed with agency and no longer listed on 905 and TCP Staffing/Clearance Identification Sheet


Note: Please submit a new Staffing List 905 and TCP Staffing/Clearance Identification Sheet whenever there are any staff changes.

 
 

Please include the start of employment for the staff member.

 
mm/dd/yyyy
 

Please visit https://community-partnership.org/wp-content/uploads/2024/03/TCP-Provider-Employee-Background-Clearance-Policy-4.pdf to learn more about each clearance level.