Edit, Download, and Sign the Sexual Misconduct Abuse Disclosure Form Pennsylvania
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How do I fill this out?
To fill out this form, you need to provide your personal information and employment history. Ensure that all sections are completed accurately to avoid any delays. Follow the detailed instructions provided in the sections below.
How to fill out the Sexual Misconduct Abuse Disclosure Form Pennsylvania?
1
Provide your personal information in Section 1.
2
Authorize your current and former employers to disclose relevant information.
3
Submit the form to your current and former employers.
4
Ensure that your employers complete Section 2.
5
Review the completed form for accuracy before submission.
Who needs the Sexual Misconduct Abuse Disclosure Form Pennsylvania?
1
Applicants seeking employment in a school entity need this form to provide information related to abuse or sexual misconduct.
2
School entities need this form to evaluate the fitness of applicants for positions involving direct contact with children.
3
Independent contractors of school entities need this form to comply with Act 168 of 2014.
4
Current employers of applicants need this form to provide information requested by prospective employers.
5
Former employers of applicants need this form to disclose information related to the applicant’s employment history.
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What are the instructions for submitting this form?
Submit the completed form to your prospective school entity or independent contractor via the contact information provided in the form. Ensure all sections are accurately filled. You can submit the form via email, fax, or physical mail as per the instructions given by the employer.
What are the important dates for this form in 2024 and 2025?
The form submission dates for 2024 and 2025 will depend on the specific school's hiring schedule and deadlines. Ensure to check with the respective school entity for key dates.
What is the purpose of this form?
This form is designed to ensure the safety of students by requiring applicants for positions in school entities to disclose any history of abuse or sexual misconduct. By mandating this disclosure, the Pennsylvania Department of Education aims to create a safer environment for children. It also facilitates the hiring process by providing a standardized method for obtaining relevant information from applicants and their former employers.
Tell me about this form and its components and fields line-by-line.
- 1. Applicant's Name: The full name of the applicant including first, middle, and last names.
- 2. Former Names: Any former names by which the applicant has been identified.
- 3. Date of Birth: The applicant's date of birth.
- 4. Last 4 Digits of Social Security Number: The last four digits of the applicant's social security number.
- 5. PPID (if applicable): The applicant's PPID if applicable.
- 6. Approximate Dates of Employment: The approximate dates during which the applicant was employed by the listed entity.
- 7. Positions Held: The positions held by the applicant with the listed entity.
- 8. Employer Verification: Fields in Section 2 to be completed by the applicant’s current and former employers.
- 9. Applicant’s Certification: A section where the applicant certifies that the information provided is true and complete.
- 10. Applicant’s Signature: The applicant's signature to authorize the release of information.
What happens if I fail to submit this form?
Failure to submit this form may result in a denial of employment or disciplinary action.
- Denial of Employment: Applicants may not be considered for employment if the form is not submitted.
- Disciplinary Action: Existing employees may face disciplinary actions for failing to complete the requirements.
How do I know when to use this form?
- 1. New Employment: When applying for a new job within a school entity.
- 2. Contractor Position: When seeking a contractor position involving direct contact with children.
- 3. Renewing Employment: When renewing employment in a position that involves direct contact with children.
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