PDE-6004: Act 24 Arrest/Conviction Report and Certification Form

PDE-6004 PDF Details

Employees completing this form are required to submit it to the administrator or other person responsible for employment decisions in a school entity.

72 hours: written notice within seventy-two (72) hours after a subsequent arrest or conviction for an offense enumerated under 24 P.S. §§1-111(e) or (f.1).

Child abuse: report having been named as a perpetrator of a founded report of child abuse within the past five (5) years as defined by the Child Protective Services Law.

Certification: by signing this form, you certify under penalty of law that the statements made in this form are true, correct and complete.

Questions: contact a supervisor or the school entity administration office with any questions, including to whom the form should be sent.