Sc Dss Form 2964 PDF Details

Are you a South Carolina resident wondering what form DSS 2964 is and why it's necessary? Look no further. This blog post will give you an overview of the purpose behind this document created by the Department of Social Services in South Carolina, how it affects you as an individual or family depending on your circumstances, and provide resources for more information if needed. With these details, you'll be able to make sure that all aspects related to this form are properly addressed so that your needs are fulfilled. So keep reading to learn all there is to know about SC DSS Form 2964!

QuestionAnswer
Form NameSc Dss Form 2964
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesdss form 2963, sc dss form 2964, Licensing, DSS

Form Preview Example

License/Registration/Approval No.:

South Carolina Department of Social Services

Child Care Licensing and Regulatory Services

SECTION 3: CURRENT CHILD CARE FACILITY STAFF/CAREGIVER CHECKLIST

Name of Facility:

 

County:

To be completed by the child care facility operator – include emergency personnel

Date:

For DSS Child Care Licensing Only

To Be

Name

Position

Date of Birth Social Security Number

Employment Start Date

Employment End Date

Days/

Hours on

Duty

Example:

M-F/8-5

Primary Age Group Assigned

Years of Experiences

Collected/

 

 

 

 

 

 

 

 

 

 

 

Verified by

 

To Be Maintained in Employee File

Licensing

 

 

 

 

 

 

 

 

 

 

 

Specialist

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ed. Level Verified*

CPR Infant/Child

First Aid

DSS Form 2901

 

DSS Form 2924

DSS Form 2925

DSS Form 2926

TB Test

SLED Results

Fingerprint Results

All Policies

BBP Training

Training Record

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total Staff:

 

(Page

 

of

 

)

*Verify educational level by listing the diploma or degree

Use additional pages if necessary

DSS Form 2964 (MAR 10) Edition of MAR 94 is obsolete.

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Step # 1 in completing 2964 sc dss

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Stage # 2 for filling out 2964 sc dss

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