Personnel Information Form

This form may be submitted to DHS for each employee at the time of initial licensing or when requested by DHS. If submission is requested please include supporting documents such as post-secondary transcripts, diplomas, or certifcates. Be sure that transcripts include the name of the post-secondary institution and the name of the staf person printed on the transcript by the post-secondary institution. This information must also be maintained in each staf person’s personnel fle on-site. All staf must meet applicable staf qualifcations as required in Minnesota Rules, parts 9503.0030, part 9503.0031, part 9503.0032, part 9503.0033, and part 9503.0034.