Use this stepbystep guide to complete the act 24 pde 6004 form promptly and with ideal precision. The act 24 arrest conviction report form is available for you to access 247 on the district website and is available upon request from the human resources department. If you are interested in testing a free faceswapping app, though, this is a decent one to start with as long as youre willing to find the right images to work with. Pde 6004 arrest conviction report instructions hermitage school. Pde 6004 arrestconviction report and certification form. While our current school year has moved online, we are looking forward to welcoming our newest little panthers this fall. Teacher candidates are required to complete an arrest conviction report before starting their student teaching experience.
Clearances and arrest conviction report info you will need to get the following three clearances and sign an arrest conviction report. Act 24 background checks instructions allegheny intermediate unit sep 28, 2011. Pde form 6004 arrest and conviction affirmationpdf. Clearance information human resources leechburg area. Act 24 form fill out and sign printable pdf template. Please complete and submit to the human resources department. Act 34 criminal background check pde form 6004 pdf within 72 hours of any arrest or conviction of an offense listed in section 111e. Submitted clearances are legal as long as the student is continuously enrolled in the university course, as stated in act 114. Child abuse clearance northwest tricounty intermediate unit.
Clearance links and employment forms human resources. For each arrest for or conviction of any reportable offense, specify in the space below or on. Page2of2 instruciions this standardized form has been developed by the pennsylvania department of pursuant to 24 p. School personnel heath record personnel health record pdf document. Act 24 arrest conviction report form updated march 2016 pde 6004. Pde 6004 form, along with completion of the act 168 form. Act 24 of 2011 and act 82 of 2012 pde form 6004 sycsd. Currently valid copies of the following 6 items must be on file before any student enters any school representing shippensburg university. For each arrest for or conviction of any reportable offense, specify in the space below or on additional attachments if necessary the offense for which you have been arrested or convicted, the date and location of arrest and or conviction, docket number, and the applicable court. 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 111e. Act 24 pde arrest conviction report and certification form, act 34 criminal record check, act 151 pennsylvania child abuse history clearance, act 114 fbi fingerprint arrest record, act 31 mandatory child abuse reporter training. Clearances are due the first week of the semester apply several weeks in advance. Arrest conviction report and certification form pde 6004 form.
Helpers must sign this helper affidavit and pde 6004 arrest conviction report and certification form each time they help in the school. Act 24 form fill online, printable, fillable, blank. No arrest or conviction by checking this box, i state that i have. Details of arrests or convictions for each arrest for or conviction of any reportable offense, specify in the space below or on additional attachments if necessary the offense for which you have been arrested or convicted, the.
This form should be used to make reports of any arrests or convictions to missy brady, hr coordinator. Details of arrests or convictions for each arrest for or conviction of any reportable offense. Arrest or conviction by checking this box, i state that i have not been arrested for or convicted of any reportable offense. This standardized form pde6004 has been developed by the pennsylvania department of education, pursuant to 24 p. Any current employee who completed a pde6004 on or before december 27, 2011, in compliance. This form should be used to make reports of any arrests or convictions to missy. The commonwealth of pennsylvan ia legislation recently amended the child protective services law, as well as the sc hool code requirements for new and current school district employees. Volunteer information south eastern school district. The act 24 arrestconviction report form is available for you to access 247 on the district website and is available upon request from the human resources department. Helpers must sign this helper affidavit and pde 6004 arrestconviction report and certification form each time they help in the school.
Act 24 pde arrestconviction report and certification form, act 34 criminal record check, act 151 pennsylvania child abuse history clearance, act 114 fbi fingerprint arrest record, act 31 mandatory child abuse reporter training. Arrest conviction report and certification form under act 24 of 2011 and act 82 of 2012, all sycsd employees are required to report to the district within 72 hours of any arrest or conviction of any criminal offense listed in section 111e and section 111f. For any arrest or conviction of any reportable offense, specify in the space below or. Act 24 of 2011 arrestconviction reporting requirements. Pdf you can immediately tell it is more than just a quick clip editor. Act 24 form fill online, printable, fillable, blank pdffiller. Please complete this form is you need to report an arrest or conviction and return it to the director. Act 114 fbi clearance pde for education students fingerprinting. If an employee refuses to submit the form, act 24 requires that the school administrator submit the. The school district or university can request clearances be renewed. Teacher candidates are required to complete an arrestconviction report before starting their student teaching experience. Tb results ppd mantoux test now required valid for two years from date of test. I affirm that i have no known report of criminal records or recorded incidence of child abuse as it applies to the school code regulations. Arrestconviction report and certification form under act 24 of 2011 and act 82 of 2012, all sycsd employees are required to report to the district within 72 hours of any arrest or conviction of any criminal offense listed in section 111e and section 111f.
They then will send the entire packet to the districts human resources office. Certification by signing this form, i certify under penalty of law that the statements made in this form are true, correct, and complete. Clearance submission instructions for field experience classes. Pde 6004 arrestconviction form pde 6004 arrestconviction form. Human resources criminal history record clearances. Passing scores on the current basic skills asses sment. Act 168 sexual misconduct form act 168 commonwealth of pennsylvania sexual misconduct abuse disclosure release. Human resources volunteer application and information. Under act 24, all current school employees are required to complete, sign and return the enclosed pde 6004 form to the human resources. These specific requirements that impact all current northwestern lehigh school district employees are outlined below.
Arrestconviction report and certification form pde6004 form. Any current employee who completed a pde6004 on or before december 27, 2011, in compliance with 24 p. Arrestconviction report and certification form under act 24 of 2011 and act 82 of 2012 section 1. Employees have 30 days from their date of hire to complete and submit this form. Ni employment application general mclane high school. 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 111e. For each arrest for or conviction of any reportable offense, specify in the space below or on additional attachments if necessary the offense for which you have been arrested or convicted, the. Arrestconviction report and certification form under act 24. To be completed by building administrator the building principal must sign the volunteer recommendation form confirming that the packet is completed. Check law under act 82 of 2012 and availability of revised pde6004 form to report arrests and convictions of offenses.
Admission and retention teacher education process every. Act 24arrest conviction report form updated march 2016 pde 6004. Pde6004 arrestconviction report and certification form. Pde6004 arrestconviction report act 24 misconductabuse disclosure forms act 168 please be advised that incomplete applications may delay hiring process. The advanced tools of the editor will lead you through the editable pdf template. Child abuse clearance the pennsylvania child abuse history clearance application can be submitted online. Admission to teacher education and change of major from. Arrestconviction report and certification form under act. Employment and volunteers pde6004 arrestconviction form. For each arrest for or conviction of any reportable. Act 24arrest conviction report form updated march 2016 pde. Upon hire applicants are required to obtain a tb test and a physical. Arrest conviction report and certification form under act 24 of 2011 and act 82 of 2012 section 1.
The form should be filled out by the candidate and returned to the field placement office. The way to complete the online act 24 form on the internet. See page 3 of this form for a list of reportable offenses. Act 24arrest conviction report form updated march 2016. Arrestconviction report and certification form under act 24 of2011 and act 82 of2012 section 1.
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