This standardized form has been developed by the Pennsylvania Department of Education, pursuant to Act 168 of 2014, to be used by school entities and independent contractors of school entities and by applicants who would be employed by or in a school entity in a position involving direct contact with children to satisfy the Act s requirement of providing information related to abuse or sexual misconduct. As required by Act 168, in addition to fulfilling the requirements under section 111 of th.

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How to fill out the Sexual Misconduct/Abuse Disclosure Release Form online

Filling out the Sexual Misconduct/Abuse Disclosure Release Form is an essential step for individuals seeking employment in positions involving direct contact with children. This guide provides clear and supportive instructions on how to complete the form online, ensuring you understand each section and entry required.

Follow the steps to complete your form online

  1. Click ‘Get Form’ button to obtain the Sexual Misconduct/Abuse Disclosure Release Form. Open it in your preferred digital editor.
  2. Begin by entering your full name in the 'Applicant’s Name' section. Include your first, middle, and last name as required.
  3. If applicable, provide any former names used. This ensures proper identification throughout the process.
  4. Enter your date of birth (DOB) in the provided field to confirm your identity.
  5. Input the last four digits of your Social Security Number (SSN) to further verify your identity.
  6. If you have a Pennsylvania Professional Identification (PPID) Number, enter it in the appropriate field.
  7. Indicate your approximate dates of employment with the current or former employer listed above by providing a start and end date.
  8. Specify the position(s) you held at the listed employment to provide additional context.
  9. Answer the questions in SECTION 1 regarding any history of abuse or misconduct. Select 'Yes' or 'No' for each question as applicable.
  10. Sign the form to certify that the information provided is true and accurate. Ensure you date your signature.
  11. After completing SECTION 1, the hiring school entity or independent contractor will submit the form to your current and former employers to complete SECTION 2.
  12. Once all sections are filled out and submitted, review the entire document for accuracy before proceeding to save it.
  13. Save your changes, and then choose to download, print, or share the Sexual Misconduct/Abuse Disclosure Release Form as needed.

Complete your Sexual Misconduct/Abuse Disclosure Release Form online to ensure a smooth application process.

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What is a Act 168 form?

It requires that anyone who applies to work directly in or around schools, and who may possibly have direct contact with children, to provide detailed background information from their current employer, and all previous employers if that employment included direct contact with children.

Sexual Misconduct Declaration Per the law, applicants must complete a declaration disclosing if they: Are the subject of any substantiated findings of sexual misconduct in any current or past postsecondary employment. Are currently being investigated for sexual misconduct at any current or past postsecondary employer.

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