Pennsylvania Paperwork

Pennsylvania BCBA Checklist & Printable Instructions (6 pages)

Print the checklist and instructions, review carefully, sign and return page 1. 

Act 24: Arrest Conviction Disclosure

For the written reporting of any arrest or conviction for an offense enumerated under 24 P.S. §§1-111(e) and (f.1). Must be completed upon initial submission of paperwork and renewed annually in July. 

Pennsylvania Child Abuse Clearance

Child Abuse Clearances must be within 12 months of Date of submission and be for "employment" purposes. Cost is between $8.00 and is paid for by the employee. 

1. Complete online at https://www.compass.state.pa.us/CWIS.

2. Select "Create Individual Account"

3. Retrieve your results instantly or within ten business days by entering the website and selecting "individual login"

4. Print & save the document as a pdf for submission and for your records. 

Pennsylvania Criminal History Clearance

Child Abuse Clearances must be within 12 months of Date of submission and be for "employment" purposes. Cost is between $22.00 and is paid for by the employee. 

• 1. Go to the Pennsylvania Access Criminal History website and apply for the criminal record check online with the Pennsylvania State Police at: epatch.state.pa.us/Home.jsp.

  2. Click “Submit a New Record Check” (DO NOT select the ‘Volunteer Only’ option)

  3. Retrieve your results: If your results do not appear instantly, log back into the site within 24 hours and select "Check the status of a record check". A confirmation page should appear- this is NOT your official results. Locate the"certification form" link where you can print or download your official results. (The document should include the PA seal)

If you have questions about the Pennsylvania State Police Request for Criminal Record Checks form (SP4 164), please call: (717) 783-9973 or toll free 1-888-783-7972. 

Sexual Misconduct/Abuse Disclosure

1. Print one form for every previous employer where you have had direct contact with children and received paid compensation (this does NOT include internships or volunteer work). 

2. Fill in top section of Application with previous/current employers contact information (note the contact person email or fax that is handling ACT 168) 

   1. a. * If you have not had any prior paying jobs with children, mark the box on the top right of the page.

3. Complete only Section 1. 

4. Review for accuracy; Leaving Section 2 Blank 

5. Return form(s) to Behavior Interventions (not your previous employer). We will contact your previous/current employer to complete the remaining sections. Forms sent directly to previous/current employers will NOT be accepted. 

Federal Background Clearance

Dept. of Human Services Clearance Required for Employment. A different FBI check is required for the PA Behavior Specialist license (LBS) application. Refer to your LBS worksheet for details.

This must be dated within 1 year of submission of paperwork and is renewed every three years. Cost is ~ $22.00 and is paid for by the employee. 

1. Go to https://uenroll.identogo.com/

2. Enter: 1KG756 (for DHS)

   1. Note: if you are seeking day-time hours you *may* be selected for a school-based case. In this event you will also need a Dept. of Ed FBI clearance. If you would like to proactively obtain this now in addition to the DHS, use the following code: 1KG6S7 (other PDE codes may apply)

1. Select “Schedule or Manage Appointment”

2. Follow prompt for enrolling and finding a printing location

3. DHS Results will be mailed to you within ~3-4 weeks after printing.

4. Send via PDF format if submitting electronically

5. Note: if you are seeking day-time hours you *may* be selected for a school-based case. In this event you will also need a Dept. of Ed FBI clearance. If you would like to proactively obtain this now in addition to the DHS clearance, follow the instructions above and use the following code: 1KG6S7 (other PDE codes may apply). 

   1. NOTE: you will only be able to access your unofficial results ONE TIME. Before exiting the unofficial results be sure to download the document AND print the document as we will need this for your compliance items. 

Mandated Reporter Training

This training is free of charge and meets both the ACT 31 and Act 126 Requirements. This training must be dated within 5 years of paperwork submission and renewed every 5 years. The training takes three hours and must be done on a desktop or laptop computer.

• 1. Go to www.reportabusepa.pitt.edu (if you have not previously registered, please click “Registration” Link at the top of the page.

  2. Go to the "Registration" tab to create a username and password

  3. Complete the 3 hour training and Print and/or save the certificate (PDF format)

CPR & First Aid Certification

Certification(s) must be current at all times. See specifications below. 

• Completed through an accredited agency (American Red Cross or American Heart Association accepted)

• Include Adult & child/pediatric

• Completed in part in person (online only courses are NOT accepted)

• PDF format if submitting electronically

Looking for a course? Check out http://www.redcross.org/ux/take-a-class

Behavior Interventions hosts CPR/First Aid Trainings at varied dates/times. To see the current training schedule and to register, click the links below.

Payment Form

View Schedule & Register

TB Clearance & Health Appraisal

TB clearances must be dated within two years and kept current (every two years). Health Appraisal is dated within one year and kept current (annually). 

It is your responsibility to visit with your doctor and obtain this test and assessment. Behavior Interventions does not cover the cost of this test or office visit.  Please, request something in writing from a physician that indicates your test is negative. See TB form for an option form to present your physician. See below on options to obtain this clearance:

• 1. You can make an appointment with your primary physician

  2. You can contact your local County Department information for free testing dates

  3. You can walk into many pharmacies without an appointment for this test (ex. CVS, Walgreens & Minute Clinic)

Resume

Resume should meet the following specifications:

• Must include your new role with Behavior Interventions

• Must be clear and legible

• PDF format if sending via email

• Include month & year for ALL previous employment dates

• Include month & year for ALL education programs

• Must document any gaps in employment longer than 6 months (including jobs not related to your profession, volunteering, family leave, etc.)

Recommendations:

(see outline for guidance)

• Include only relevant experience to the field of applied behavior analysis

• Specify related skills, coursework, and work activities specific to applied behavior analysis

Degree

Please include your HIGHEST conferred (completed) degree. Degree should meet the following specifications:

• 1. PDF Format if sending electronically: Clear and legible

  2. Include: Your full name, Institution Name, Dates of attendance; INCLUDING graduation date 

  3. Acceptable: High School/University Diploma OR conferred college transcripts(unofficial/official). 

  4. In addition, please include college transcripts for for any current degrees that you are working toward

PDF format if submitting electronically

Drivers License/Photo ID

Driver’s license should meet the following specifications : 

• 1. Image must be clear and legible 

  2. Include: Date of birth, identification number

  3. PDF format if submitting electronically