Embedded Files
One form must be completed for each employer/agency through whom you have had contact with minors.
As long as Section 1 has been completed and signed for each organization and you have provided a phone and/or fax # for that organization, our HR Department will be glad to send these out on your behalf.
If you choose to send the form(s) out yourself, please complete the last section as noted above.
In conjunction with the Act 168 Forms, a complete accounting of all organizations through whom you have worked with minors, which should mirror your resume
A current, up-to-date Act 24 Arrest/Conviction form will be needed each year.
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