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Sexual Misconduct / Abuse Disclosure Release (Under Act 168 of 2014) - Pennsylvania
What Is the Act 168 Form?
The Sexual Misconduct/Abuse Disclosure Release (Under Act 168 of 2014) is a legal document that must be completed to disclose possible sexual misconduct or abuse history of an applicant under consideration for a position with a Pennsylvania school entity. It serves as an additional safeguard in the hiring process of school employees and ensures the safety of students.
Alternate Name:
- Act 168 Form.
If an employee is going to have regular contact with students, it is necessary to obtain an Act 168 Form to request information regarding child abuse and sexual misconduct. Without a completed disclosure, it is prohibited to hire an applicant for any school position. A proper employment history review, including completion of this disclosure, is required for all public schools, private schools, intermediate units, and vocational-technical schools that operate within Pennsylvania.
This form was released by the Pennsylvania Department of Education . You can download a fillable Act 168 Form through the link below.
How to Fill Out Act 168 Form?
There are several steps to completing the Act 168 Form since it must be filled out by three different people:
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The hiring school entity or independent contractor must write down the details of all current and former employers - their names, addresses, telephone numbers, emails. Name the individuals to be contacted and indicate their titles. If there is no applicable employment, check the appropriate box. State the name and contact information of the school entity or independent contractor on the last page of the disclosure. When you receive the completed form, write down the date you received the disclosure and name the individual who did it.
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Applicants must state the following information: full name, former names, date of birth, last four digits of their social security number, professional personnel identification number, dates of employment with the employer named above, and position within this entity. The applicant signs the form, writes down the actual date, and answers "yes" or "no" to the following questions:
- Have you ever been the subject of an abuse or sexual misconduct investigation, unless the allegations were false;
- Have you ever been separated from employment while the allegations of abuse or sexual misconduct were pending;
- Have you ever had a license or certificate suspended or revoked while the allegations were pending;
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The current or former employer must complete the second section of the disclosure within twenty calendar days from the day the document was received. If you give an affirmative response, every measure must be taken to protect student privacy and confidentiality - redact all student identifiers prior to release. Record the dates of employment of the applicant and provide the contact telephone number. It is required to answer "yes" or "no" to the same abuse or sexual misconduct questions, after which the employer's representative signs and dates the form.
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