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Get Pa Verification Of Residency Form

-State offense similar in nature to those crimes listed under paragraphs (1) and (2). By checking this box I state that I have not been convicted of any of the Prohibitive Offenses Contained in Act 14 of 1997 (set forth in 63 P.S. 675 and found on the following page). I understand that if I have been convicted of any of the criminal offenses set forth in 63 P.S. 675(a)(1)-(3), it is possible that I will not be eligible for employment in a long term care or other health care setting. A po.

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