How to Fill Out and Submit the Pennsylvania Act 168 Form: Employers and Steps

The Pennsylvania Act 168 form, formally the Commonwealth of Pennsylvania Sexual Misconduct/Abuse Disclosure Release, is a standardized disclosure every applicant for a Pennsylvania school position with contact with children must complete before being hired.¹ You fill out Section 1, which lists specific past employers, answers three yes-or-no questions about misconduct history, and authorizes those employers to share what they know. The hiring school then sends a copy of your form to each employer you listed, and those employers have 20 days to respond.²

Who Has to Fill It Out

Act 168 applies to anyone being hired for a position with direct contact with children at a Pennsylvania school entity or through an independent contractor that serves one. Direct contact with children means the possibility of care, supervision, guidance, or control of children, or routine interaction with them.³ That covers teachers and aides, but it also covers counselors, bus drivers, cafeteria workers, custodians, and staff of contracted companies working inside a school. Volunteers are not covered. The law reaches employees and independent contractors only.

Where to Get the Form

The Pennsylvania Department of Education publishes the form as a downloadable PDF on its website.⁴ In practice, the school’s human resources office usually hands it to you with the rest of your new-hire paperwork. You will need one copy for each employer you have to list, because the hiring school sends a separate copy to each one.

Which Employers You Must List

This is where applicants most often get it wrong. You are not listing every job you have ever held. Act 168 asks for three categories:¹

Your current employer, whether or not it is a school and whether or not you work with children there. A current retail job still goes on the form.
Every former school entity employer — public school, charter or cyber charter school, private or nonpublic school, intermediate unit, or area vocational-technical school — regardless of whether your role involved children.
Every former non-school employer where you had direct contact with children. Daycare centers, summer camps, youth sports organizations, and after-school programs all qualify.

For each one, you provide the organization’s name, address, your supervisor’s name, a phone number or other contact for verification, and your employment dates. Look these up before you start writing. Guessed dates and misspelled names slow the verification process and, at worst, can look like dishonesty.

The Three Questions and the Signature

Section 1 asks you three yes-or-no questions:¹

Have you ever been the subject of an abuse or sexual misconduct investigation by any employer, state licensing agency, law enforcement agency, or child protective services agency?
Have you ever been disciplined, discharged, non-renewed, or asked to resign while allegations of abuse or sexual misconduct were pending or under investigation, or because of a finding of abuse or sexual misconduct? This also covers resigning on your own while an investigation was open.
Has any professional license, certificate, or credential of yours ever been suspended, surrendered, or revoked while misconduct allegations were pending or because of a finding of misconduct?

Answer honestly. A yes answer does not automatically disqualify you, but lying will. The form carries a notice that false statements are punishable, which brings it under Pennsylvania’s unsworn falsification statute. A false written statement on a form bearing that notice is a third-degree misdemeanor, carrying up to one year in jail and a minimum fine of $1,000.⁵

Sign the authorization at the bottom of Section 1. Your signature gives each listed employer permission to disclose misconduct-related information to the hiring school and releases those employers from civil and criminal liability for good-faith disclosure.² The hiring school cannot move your application forward without complete information and this signed consent.

What Happens After You Submit It

Once you hand in your completed Section 1, the hiring school takes over. If you are still in the running, the school sends a copy of your form to each employer you listed. Those employers fill out Section 2, confirming or contradicting what you said about investigations, separations tied to misconduct, and credential actions.¹ Each former employer has 20 days from receiving the request to respond.²

If a response documents a history of sexual misconduct or abuse, the hiring school is prohibited from employing you. The law gives the school no discretion on that point.

Starting Work Before All Responses Come In

Former employers do not always respond on time, and schools often need to fill positions quickly. When responses are still outstanding, the school can bring you on under provisional employment for up to 90 days if three conditions are met:¹

You fully completed and signed Section 1.
The hiring administrator has no information that would disqualify you.
You swear or affirm that nothing in your background bars you from the position.

Provisional status comes with real limits. You cannot work alone with children, and you must stay in the immediate vicinity of a permanent employee at all times. If the outstanding responses come back clean within 90 days, you move into regular employment. If one reveals disqualifying information, your employment ends.

What Act 168 Does Not Replace

The disclosure form runs alongside, not instead of, Pennsylvania’s three required background clearances for school workers: the Pennsylvania State Police criminal records check, the Department of Human Services child abuse history clearance (ChildLine), and the federal FBI fingerprint check.⁶ Each of those is a separate application with its own fees and processing time. Submitting Act 168 does not satisfy any of them.

1
Commonwealth of Pennsylvania. Act 168 of 2014 – Procedures and Forms
2
Pennsylvania General Assembly. Pennsylvania Statutes Title 24 PS Education 1-111.1 – Employment History Review
3
Pennsylvania Department of Education. Act 168 Employment History Review FAQ
4
Pennsylvania Department of Education. Commonwealth of Pennsylvania Sexual Misconduct/Abuse Disclosure Release
5
Pennsylvania General Assembly. Pennsylvania Consolidated Statutes Title 18 4904 – Unsworn Falsification to Authorities
6
Pennsylvania Department of Education. Clearances – Background Checks