A GUIDE TO OBTAINING CLEARANCES Child Abuse History Clearance Pennsylvania State Criminal Background History FBI Clearance

A GUIDE TO OBTAINING CLEARANCES Child Abuse History Clearance Pennsylvania State Criminal Background History FBI Clearance PENNSYLVANIA CHILD ABUSE HISTORY CLEARANCE You may obtain your Child Abuse History Clearance in one of two ways: METHOD #1 - Online through the Department of Human Services Child Welfare Portal This method is the most expedient in terms of obtaining your results. It requires a credit/debit card payment. The cost of the clearance is $8.00. In your internet browser, type www.compass.state.pa.us/cwis Select Create Individual Account (if you have not created an account previously) General Information will be shared o Scroll to the bottom of the page and click Next Profile Information in order to establish your Keystone Key account will be requested o Enter requested information and click Finish Check your email account for your temporary password Log into the Child Welfare Portal again and click Individual Login Select Access My Clearances o Read through the website and disclosure information and click Continue Enter your Keystone Key username and password (copy and paste your password from your confirmation email) o Click Login Set your Permanent Password o Click Submit and then click Close Window Log back in to the Child Welfare Portal with your new password Review the Terms and Conditions o Check the box next to I have read, fully understand and agree to the My Child Welfare Account Terms and Conditions and click Next Review the Disclosure of Personal Information o Click Continue Click Create Clearance Application Information you will need includes: o Addresses for places of residence since 1975 o Names of all individuals you resided with since 1975, to include parents, guardians, siblings, spouses/partners, etc. o Any previous names you have used or have been known by o Credit/debit card information for the $8.00 clearance fee Click Begin at the bottom of the page A Guide to Obtaining Clearances, Rev. 1/23/2018 Page 1

On the Application Purpose page, select School Employee Governed by Public School Code and click Next Enter your Applicant and Contact information o Scroll down to the bottom of the page and click Next Enter Current Address, Mailing Address, and Certificate Delivery Method and click Next Add Previous Addresses and click Next Add all current and previous Household Members and click Next Review your Application Summary and click Next Enter your Application Payment and click Next Enter your esignature o Check the box certifying that the information is correct o Enter your first and last name in the signature box and click Next Application Payment o Select yes or no to the question posed (when no is selected, you will be prompted to Make a Payment) Click Make a Payment o Enter your credit/debit card information o Scroll to bottom of page and click Pay Now Payment Completed o Click Finalize and Submit Application You will be prompted to check your email for a confirmation notification o You may log in to view or check the status of your application from the PA Child Abuse History Clearance Account at any time o Once your application has been finalized, you will receive an email to log in to your account and view/print the outcome/clearance results o If you do not receive an email with 30 days of submission, contact the ChildLine and Abuse Registry s Child Abuse History Clearance Unit at 1-877-371-5422 METHOD #2 - By Mail This method may take up to eight (8) weeks to obtain results and requires an $8.00 money order. Clearance forms may be obtained through the Office of Human Resources or may be downloaded: Visit the BCIU website at www.berksiu.org Click Check out available job opportunities at BCIU (on right side of page) Click Applications and Clearances Access either the English or Spanish application forms located within the Pennsylvania Child Abuse History Clearance ($8.00) section In an effort to expedite your paper application, you are encouraged to the take your completed application form and $8.00 money order to State Senator Judy Schwank s office: 210 George Street Muhlenberg Township 610-929-2151 A Guide to Obtaining Clearances, Rev. 1/23/2018 Page 2

Upon receipt of your results, present your clearance certificate to your current or prospective employer. BCIU employees should present their certificate to the Office of Human Resources. Keystone Key ID: Password: NOTES A Guide to Obtaining Clearances, Rev. 1/23/2018 Page 3

PENNSYLVANIA STATE POLICE REQUEST FOR CRIMINAL RECORD CHECK You may obtain your Pennsylvania Criminal Background Clearance in one of two ways: METHOD #1 - Online through the Pennsylvania State Police epatch website In most cases, results will appear instantaneously if no record exists. Online submission requires a credit/debit card payment. The cost of the clearance is $22.00. In your internet browser, type https://epatch.state.pa.us Scroll to the Credit Card Users section and select Submit a New Record Check Read the terms and conditions for the use of PATCH o Scroll to the bottom of the page and select Accept Enter the required Personal Information o Under Reason for Request, use the drop-down menu to select Employment o Click Next Personal Information Review (verify the information you entered) o Click Proceed Enter all requested information contained on Record Check Request Form Click Enter this Request Click View Queued Record Check Requests (1) Review your Record Check Request information and click Submit Enter your payment information and click Next Verify your payment information and click Submit Record Check Request Results will appear after being processed o Click Control # to view the details of your record check Click Certification Form to open a new browser window with the official clearance certification document for your records (NOTE: You will not receive a copy in the mail) o Click the printer icon to print a copy of the certificate METHOD #2 - By Mail This method may take up to eight (8) weeks to receive results and requires an $8.00 money order. Record check forms may be obtained through the Office of Human Resources or via the web: Log onto the BCIU website at www.berksiu.org Click on Check out available job opportunities at BCIU (on right side of page) Click on Applications and Clearances Click on Request for Criminal Record Check Upon receipt of your results, present your Response for Criminal Record Check certification form to your current or prospective employer. BCIU employees should present their certification form to the Office of Human Resources. A Guide to Obtaining Clearances, Rev. 1/23/2018 Page 4

NOTES My Control #: Date of Submission: Full Name Submitted Under: A Guide to Obtaining Clearances, Rev. 1/23/2018 Page 5

FBI FEDERAL CRIMINAL HISTORY CLEARANCE All applicants for employment with the Berks County Intermediate Unit are required to obtain a Federal Criminal History Record. Applicants must follow the following procedures. The fingerprint-based background check is a multiple-step process, as follows: 1. Registration - The applicant must register prior to going to the fingerprint site. Walk-in service is allowed but all applicants are required to complete pre-enrollment in the new Universal Enrollment system. Pre-enrollment can be completed online or over the phone. The registration website is available online 24 hours/day, seven days per week at https://uenroll.identogo.com. Telephonic registration is available at 1-844-321-2101 Monday through Friday, 8am to 6pm. During the pre-enrollment process, all demographic data for the applicant is collected (name, address, etc.) along with notices about identification requirements and other important information. When registering online, an applicant must use the appropriate agency specific Service Code to ensure they are processed for the correct agency and/or applicant type. Using the correct service code ensures the background check is submitted for the correct purpose. Fingerprint requests processed through any other agency or purpose cannot be accepted and are not transferrable. If an applicant enters the wrong code by mistake, the incorrect applicant type will appear at the top of the screen. The applicant should select the Back to Home button and begin the process again, by reentering the correct Service Code. If the applicant proceeds with the process under the incorrect code, the pre-enrollment and/or results cannot be transferred to another state agency and the applicant will have to start the process over and pay for the background check again. The Service Code for Guest Teachers is 1KG6S7. 2. Payment - The applicant will pay a fee of $22.60 for the fingerprint service and to secure an unofficial copy of the Criminal History Record. Credit cards as well as money orders or cashier s checks payable to MorphoTrust will be accepted on-site for those applicants who are required to pay individually. No cash transactions or personal checks are allowed. 3. Fingerprint Locations During the pre-enrollment process, an applicant must select a fingerprint site of their choice. The system will prompt the applicant to select a date/time to be fingerprinted or they may select walk-in. If choosing walk-in, please note that scheduled appointments take priority. After the registration process is completed, the applicant proceeds to the fingerprint site of their choice for fingerprinting. The location of the fingerprint sites and days and hours of operation for each site are posted on IDEMIA's website at https://uenroll.identogo.com. A Guide to Obtaining Clearances, Rev. 1/23/2018 Page 6

Note: The Berks County Intermediate Unit is a fingerprint site. Regular hours of operations: Monday: 8:00 a.m. 4:00 p.m. Tuesday: 11:30 a.m. 4:00 p.m. Wednesday: 11:30 a.m. 4:00 p.m. Thursday: 11:30 a.m. 4:00 p.m. Friday: 11:30 a.m. 4:00 p.m. Hours of operation are subject to change based on holidays, closings, delays, and summer hours. 4. Fingerprinting - At the fingerprint site the Enrollment Agent (EA) manages the fingerprint collection process. The fingerprint transaction begins when the EA reviews the applicant s qualified State or Federal photo ID before processing the applicant s transaction. A list of approved ID type may be found on the IDEMIA website at https://uenroll.identogo.com. Applicants will not be processed if they cannot produce an acceptable photo ID. After the identity of the applicant has been established, all ten fingers are scanned to complete the process. 5. Report Access For the public or private school or higher education institution to access the official report via the electronic system, applicants must present their UEID to the hiring entity (as shown on the receipt provided after fingerprint capture). This process allows an applicant to provide multiple potential employers with their UEID, as the report is linked to the UEID number and not assigned to a specific school. If an applicant has lost their receipt or needs to confirm the UEID, the applicant may visit the UEP website (https://uenroll.identogo.com/) and simply check the status of their file by providing alternate personal information. Applicants will enter their personal information after clicking in the lower portion of that screen to obtain their receipt with the UEID. Applicants will receive an unofficial copy of their report. However, the school is required to review the official CHRI online and print a file copy of the CHRI if the applicant is hired by the school or their contractor, or if the applicant is approved for student teaching. INQUIRIES More information regarding fingerprinting locations and the process for obtaining an FBI fingerprint based background check report may be found at: https://uenroll.identogo.com. Applicants and schools with policy questions may contact PDE at (717) 783-3750 or RA-PDE- SchoolService@pa.gov. Fingerprint Services Customer Service Call Center: 1-844-321-2101. Frequently Asked Questions: https://www.identogo.com/locations/pennsylvania A Guide to Obtaining Clearances, Rev. 1/23/2018 Page 7

1 of 3 ARREST/CONVICTION REPORT AND CERTIFICATION FORM (under Act 24 of 2011 and Act 82 of 2012) Section 1. Personal Information Full Legal Name: Other names by which you have been identified: Date of Birth: / / Section 2. Arrest or Conviction By checking this box, I state that I have NOT been arrested for or convicted of any Reportable Offense. By checking this box, I report that I have been arrested for or convicted of an offense or offenses enumerated under 24 P.S. 1-111(e) or (f.1) ( Reportable Offense(s) ). See Page 3 of this Form for a list of Reportable Offenses. 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 date and location of arrest and/or conviction, docket number, and the applicable court. Section 3. Child Abuse By checking this box, I state that I have NOT 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. By checking this box, I report that I have 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. Section 4. Certification By signing this form, I certify under penalty of law that the statements made in this form are true, correct and complete. I understand that false statements herein, including, without limitation, any failure to accurately report any arrest or conviction for a Reportable Offense, shall subject me to criminal prosecution under 18 Pa.C.S. 4904, relating to unsworn falsification to authorities. Signature Date PDE-6004 03/01/2016

2 of 3 INSTRUCTIONS Pursuant to 24 P.S. 1-111(c.4) and (j), the Pennsylvania Department of Education developed this standardized form (PDE-6004) to be used by current and prospective employees of public and private schools, intermediate units, and area vocational-technical schools. As required by subsection (c.4) and (j)(2) of 24 P.S. 1-111, this form shall be completed and submitted by all current and prospective employees of said institutions to provide written reporting of any arrest or conviction for an offense enumerated under 24 P.S. 1-111(e) and (f.1) and to provide notification of 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. As required by subsection (j)(4) of 24 P.S. 1-111, this form also shall be utilized by current and prospective employees to provide 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). In accordance with 24 P.S. 1-111, employees completing this form are required to submit the form to the administrator or other person responsible for employment decisions in a school entity. Please contact a supervisor or the school entity administration office with any questions regarding the PDE 6004, including to whom the form should be sent. PROVIDE ALL INFORMATION REQUIRED BY THIS FORM LEGIBLY IN INK. PDE-6004 03/01/2016

3 of 3 LIST OF REPORTABLE OFFENSES A reportable offense enumerated under 24 P.S. 1-111(e) consists of any of the following: (1) An offense under one or more of the following provisions of Title 18 of the Pennsylvania Consolidated Statutes: Chapter 25 (relating to criminal homicide) Section 2702 (relating to aggravated assault) Section 2709.1 (relating to stalking) Section 2901 (relating to kidnapping) Section 2902 (relating to unlawful restraint) Section 2910 (relating to luring a child into a motor vehicle or structure) Section 3121 (relating to rape) Section 3122.1 (relating to statutory sexual assault) Section 3123 (relating to involuntary deviate sexual intercourse) Section 3124.1 (relating to sexual assault) Section 3124.2 (relating to institutional sexual assault) Section 3125( relating to aggravated indecent assault) Section 3126 (relating to indecent assault) Section 3127 (relating to indecent exposure) Section 3129 (relating to sexual intercourse with animal) Section 4302 (relating to incest) Section 4303 (relating to concealing death of child) Section 4304 (relating to endangering welfare of children) Section 4305 (relating to dealing in infant children) A felony offense under section 5902(b) (relating to prostitution and related offenses) Section 5903(c) or (d) (relating to obscene and other sexual materials and performances) Section 6301(a)(1) (relating to corruption of minors) Section 6312 (relating to sexual abuse of children) Section 6318 (relating to unlawful contact with minor) Section 6319 (relating to solicitation of minors to traffic drugs) Section 6320 (relating to sexual exploitation of children) (2) An offense designated as a felony under the act of April 14, 1972 (P.L. 233, No. 64), known as The Controlled Substance, Drug, Device and Cosmetic Act. (3) An offense SIMILAR IN NATURE to those crimes listed above in clauses (1) and (2) under the laws or former laws of: the United States; or one of its territories or possessions; or another state; or the District of Columbia; or the Commonwealth of Puerto Rico; or a foreign nation; or under a former law of this Commonwealth. A reportable offense enumerated under 24 P.S. 1-111(f.1) consists of any of the following: (1) An offense graded as a felony offense of the first, second or third degree, other than one of the offenses enumerated under 24 P.S. 1-111(e), if less than (10) ten years has elapsed from the date of expiration of the sentence for the offense. (2) An offense graded as a misdemeanor of the first degree, other than one of the offenses enumerated under 24 P.S. 1-111(e), if less than (5) five years has elapsed from the date of expiration of the sentence for the offense. (3) An offense under 75 Pa.C.S. 3802(a), (b), (c) or (d)(relating to driving under influence of alcohol or controlled substance) graded as a misdemeanor of the first degree under 75 Pa.C.S. 3803 (relating to grading), if the person has been previously convicted of such an offense and less than (3) three years has elapsed from the date of expiration of the sentence for the most recent offense. PDE-6004 03/01/2016

H511.340 (8/2011) Position I. Patient Information COMMONWEALTH OF PENNSYLVANIA PENNSYLVANIA DEPARTMENT OF HEALTH SCHOOL PERSONNEL HEALTH RECORD Last Name First MI Sex Date of Birth Social Security Number Home Telephone Work Telephone Mailing Address Street City State Zip Usual Source of Medical Care Physician s Name Address Telephone Emergency Contact Name Relationship Address Telephone II. Immunization History VACCINE Enter Month, Day, and Year Each Immunization was Given DOSES BOOSTERS & DATES Diphtheria and Tetanus* 1. 2. 3. 4. 5. Hepatitis B 1. 2. 3. Measles, Mumps, Rubella 1. 2. Other 1. Other 1. * Tetanus and Diphtheria are usually received in combined vaccines such as DTP, DtaP, DT, or Td III. Required Tuberculosis Test Results (as per Regulations of the Department of Health DATE APPLIED ARM METHOD ANTIGEN MANUFACTURER SIGNATURE DATE READ RESULTS (mm) SIGNATURE For previously known/new positive reactors: Chest X-ray: Date: Results: Other: Date: Results: (Attach a copy of the report.) (Attach a copy of the report.) Preventive Anti-Tuberculosis Chemotherapy ordered: No Yes Date: IF SIGNIFICANT REACTION WAS REPORTED, THE PHYSICIAN REPORT MUST STATE THAT THE APPLICANT IS FREE FROM CURRENT TUBERCULOSIS DISEASE OR IS UNDER ADEQUATE CHEMOTHERAPY FOR TUBERCULOSIS DISEASE:

IV. Significant Medical Conditions ( ) Yes No If Yes, Explain: Allergies... Asthma... Cardiac... Chemical Dependency... Drugs... Alcohol... Diabetes Mellitus... Gastrointestinal Disorder... Hearing Disorder... Hypertension... Neuromuscular Disorder... Orthopedic Condition... Respiratory Illness... Seizure Disorder... Skin Disorder... Vision Disorder... Other (Specify)... V. Report of Physical Examination ( ) Height (inches) Weight (pounds) Pulse Blood Pressure Hair/Scalp Skin Eyes Visual Acuity: R L Eyes Color Vision Ears Hearing (db) R L Nose and Throat Teeth and Gingiva Lymph Glands Heart Murmur, etc Lungs Adventitous Findings Abdomen Genitourinary Neuromuscular System Extremities NORMAL ABNORMAL NOT EXAMINED COMMENTS Are there any special medical problems or chronic diseases which require restriction of activity, medication or which might affect his/her work role? If so, specify Physician Name (Print) Signature of Examiner Date Physician Address The statements and answers as recorded above are full, complete and true to the best of my knowledge and belief. I understand that any false or misleading statements may cause termination of my employment. I authorize the physician or other person to disclose any knowledge or information pertaining to my health to the employing authority for whom this examination is performed. Signature of Employee Date

Pennsylvania Emergency Permit Re-issuance Background Collection Form PDE 338 G (For 04 Long-Term Substitutes with No Education Obligation or 06 Day-to-Day Substitutes) (Refer to the instructions included with this two-page form) Section I Personal Information (please print or type) 1. Last Name First Name Middle Initial 2. Pennsylvania Personnel ID (PPID) 3. Address 4. Date of Birth (mm/dd/yyyy) City/State/Zip Code 5. Daytime Telephone Home/Cell ( ) Work Phone ( ) 7. Please list all former name(s) beginning with the most recent Last First MI Section II-Background 6. E-Mail Address 8. Are you a United States Citizen? Yes No - If you check this box you must apply online using the Teacher Information Management System (TIMS) unless teaching a World Language Read and answer each question carefully to ensure that you have selected the appropriate check box. Incorrectly checking a box may significantly delay the processing of your application. Please refer to the instruction sheet for further information. 1. Have you ever been the subject of a child abuse investigation or report in this or any other state, territory or country? (If yes, read the instructions for this question first, then indicate whether the investigation or report is pending, unfounded, indicated, or founded by checking the appropriate box.) 2. Are you currently the subject of any misconduct investigation by an employer? (If yes, refer to instructions.) Yes: Pending Unfounded Indicated Founded No Yes No 3. Have you ever resigned from or otherwise left any employment (e.g., settlement agreement) while allegations of misconduct were pending, or under investigation? (If yes, refer to instructions.) 4. Is there disciplinary action pending by a licensing agency in this or any other state, territory, or country? (If yes, refer to instructions.) 5. Have you ever had any certificate or license for any profession denied, revoked, suspended, surrendered, or received a public reprimand in this or any other state, territory, or country? (If yes, refer to instructions.) Yes No Yes No Yes No Revised: August 2015 Page 1 of 3

6. Have you ever been convicted of a crime classified as a misdemeanor or felony in this state or any other state, territory, or country? (If yes, refer to instructions.) (For purposes of this question, convicted includes pleas of nolo contendere and guilty pleas. However, summary offenses do not need to be acknowledged.) 7. Are criminal charges pending against you, or are you the subject of an inquiry or investigation by a law enforcement agency in this or any other state, territory, or country? (If yes, refer to instructions.) Yes No Yes No Note: If you answered Pending, Unfounded, Indicated, Founded, or Yes to any background question listed above, you must apply online using the online Teacher Information Management System (TIMS). Section III-Code of Conduct The Pennsylvania Code of Professional Practice and Conduct for Educators, which may be found on the PDE website, sets forth the standards for professional practice for Pennsylvania professional educators. All professional educators are expected to conduct themselves in accordance with the code. Failure to do so may result in professional discipline. Indicate that you have read the code by checking the box below. I certify that I have read and will abide by the Code of Professional Practice and Conduct for Educators. Section IV-Affidavit I certify that the information provided in this application, including all statements and documentation, is correct and true. I understand that the falsification of any statement or document may result in professional discipline, including revocation of my Pennsylvania certificate. Signature of Applicant Date Revised: August 2015 Page 2 of 3

Pennsylvania Emergency Permit Re-issuance Background Collection Form PDE 338 G Instructions Print with dark blue or black ink SECTION I: Personal Information 1. Print your last name, first name, and middle initial. 2. Print your Pennsylvania Personnel ID (PPID), available in TIMS or from the Act 48 website. 3. Print your complete address and zip code. 4. Print your date of birth. 5. Print your telephone numbers in the event you must be contacted. 6. Print your current e-mail address. 7. Print former names, if applicable. 8. Please state your citizenship status by checking the yes or no box. If you are not a U.S citizen, you must apply online using the Teacher Information Management System (TIMS) unless you are teaching World Languages. SECTION II: Background If you answered pending, unfounded, founded, indicated, or yes to any question, you must apply online using the Teacher Information Management System (TIMS) and supply the additional documentation indicated in the link included in the question. SECTION III: Code of Conduct Pennsylvania s Code of Professional Practice and Conduct for Educators may be found at: http://www.portal.state.pa.us/portal/server.pt/community/guidelines%2c_policies%2c_c omplaint_forms%2c_reports_and_related_documents_/8850/code_of_conduct/529193. Review the code at the web address listed above, and check the box indicating that you have read and will abide by Pennsylvania s Code of Professional Practice and Conduct for Educators. SECTION IV: Affidavit Complete the Affidavit section by signing and dating the form. Your signature certifies that all of the information provided is correct and true. Misrepresentation/ falsification may result in professional discipline and the revocation of your Pennsylvania certificate. COMPLETING THE FORM Return this completed form to the Local Education Agency (school district, intermediate unit, vocational school, charter school) requesting the emergency permit. Do not send the form to the Pennsylvania Department of Education. Revised: August 2015 Page 3 of 3

PA PUBLIC SCHOOL EMPLOYEES RETIREMENT SYSTEM (PSERS) GUEST TEACHER INFORMATION FORM Are you currently receiving retirement benefits from PSERS? (Please select one) YES NO Full Name (Please print) Signature Today s Date