1 of 3 ARREST/CONVICTION REPORT AND CERTIFICATION FORM (under Act 24 of 2011 and Act 82 of 2012) Section 1. Personal Information Full Legal Name: Date of Birth: / / Other names by which you have been.
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How to fill out the PA PDE-6004 online
Filling out the PA PDE-6004 form online is an essential step for current and prospective employees of educational institutions in Pennsylvania. This guide will provide detailed instructions for completing each section of the form, ensuring you provide the necessary information accurately.
Follow the steps to complete the form accurately and efficiently.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- In Section 1, provide your personal information, including your full legal name and date of birth. If you have any other names you have been identified by, include them as well.
- Move to Section 2 regarding arrests or convictions. Check the appropriate box to indicate whether you have NOT been arrested for or convicted of any reportable offense or if you have. If you have, detail each arrest or conviction including the offense, date, location, docket number, and applicable court.
- In Section 3, indicate if you have NOT been named as a perpetrator of a founded report of child abuse in the last five years or if you have. Check the corresponding box based on your situation.
- In Section 4, review the certification statement. By signing this form, you affirm that all provided information is true, correct, and complete. Be sure to include your signature and the date.
- Once all sections are completed, review your information for accuracy. You can then save changes, download the form, print it, or share it as needed.
Complete the PA PDE-6004 form online today to ensure your application process is smooth and compliant.
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Get answers to your most pressing questions about US Legal Forms API.
What is Act 24 of 2011 Pennsylvania?
Act 24 of 2011 (Act 24) amends Section 111 of the School Code, which provides for background checks for employees of public and private schools, intermediate units and area vocational-technical schools. The changes to Section 111 became effective on September 28, 2011.
What is Act 24 clearance in PA?
Required Legal Clearances. Act 24 requires all current and future employees/pre-service teachers to complete a Pennsylvania Department of Education (PDE) form to report prior arrests or convictions for any offenses listed on form PDE-6004.
How long is Act 24 clearance good for in PA?
How long are clearances good for in PA schools? The PA Criminal History clearance is valid for one year from issuance date.
What are the 3 PA clearances?
The required clearances may include: Pennsylvania Child Abuse History Clearance. Pennsylvania State Police Criminal History Clearance. Federal Bureau of Investigations (FBI) Criminal History Clearance. (required for all employees and some volunteers)
What is PA Act 24 of 2003?
Act 24, which lowered Pennsylvania's legal limit of alcohol from . 10 to . 08, was signed into law on September 30, 2003.
What is a PDE 6004 form?
Act 24: Reporting Arrests and Convictions Additionally, Act 24 requires that all school employees complete and return to their school administrator a PDE Form 6004 (PDF) within 72 hours of any arrest or conviction of an offense listed in Section 111(e).
What is PA Public school Code Section 111?
Section 111 requires that the school administrator or other person responsible for employment decisions in a school entity review the background check reports and determine whether prospective employees, contractors, or their employees are barred from positions in which they will have contact with children before ...
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