Pennsylvania Act 24 Form (PDE-6004): Filing, Deadlines, and Penalties

The PDE-6004 form is Pennsylvania’s Arrest/Conviction Report and Certification Form, a one-page filing that school employees use to report a reportable arrest or conviction to their administrator within 72 hours, and that new hires use to certify they have no disqualifying criminal history. Download the current fillable PDF from the Pennsylvania Department of Education’s background checks page, complete your identifying information and the disclosure section, sign it, and deliver it to the person your district has designated to receive it.¹

Who Has to File

The reporting requirement under 24 P.S. § 1-111 reaches every current and prospective employee of a Pennsylvania public school district, private school, intermediate unit, or area career and technical school. Teachers, administrators, custodians, cafeteria workers, bus drivers, support staff — all covered.²

Independent contractors and their employees are also covered if they have direct contact with children, meaning the possibility of supervising, guiding, or controlling children, or having routine interaction with them. Job title does not matter. Length of service does not matter.

Which Offenses Require a Filing

The form is not for every criminal matter. It applies only to offenses listed in two subsections of the Public School Code: Section 111(e), which permanently disqualifies a person from school employment, and Section 111(f.1), which creates a time-limited bar.

Permanently Disqualifying Offenses Under Section 111(e)

A conviction under Section 111(e) permanently bars school employment, and an arrest for any of these offenses triggers the 72-hour clock:³

Violent crimes: criminal homicide, aggravated assault, stalking, kidnapping, and unlawful restraint.
Offenses against children: luring a child into a vehicle or structure, endangering the welfare of children, dealing in infant children, concealing the death of a child, corruption of minors, and solicitation of minors to traffic drugs.
Sexual offenses: rape, statutory sexual assault, involuntary deviate sexual intercourse, sexual assault, institutional sexual assault, aggravated indecent assault, indecent assault, indecent exposure, incest, sexual abuse of children, unlawful contact with a minor, and sexual exploitation of children.
Felony prostitution and distribution of obscene materials involving minors.
Any felony under Pennsylvania’s Controlled Substance, Drug, Device and Cosmetic Act.
Any similar offense from another state, the federal system, or a foreign country.

Time-Limited Bars Under Section 111(f.1)

These offenses also require 72-hour reporting, but the bar runs from the date the sentence expires rather than lasting forever:³

Any felony not already covered by Section 111(e): ten years after the sentence expires.
Any first-degree misdemeanor not already covered by Section 111(e): five years after the sentence expires.
Multiple DUI convictions under 75 Pa.C.S. § 3802 graded as a first-degree misdemeanor: three years after the most recent sentence expires.

A single DUI graded below a first-degree misdemeanor is not on either list and does not require a PDE-6004 filing. Grading depends on blood alcohol level and prior offenses, so check the actual grading on your court paperwork rather than assuming.

How to Fill Out the Form

Pull the current version straight from the Department of Education’s background checks page. A copy from a third-party site may be outdated. The PDF is fillable, so you can type your entries before printing and signing.¹

Personal Information

Enter your full legal name, current address, and other identifying details exactly as they appear on your government-issued ID. This links the form to your personnel file.

Arrest or Conviction Disclosure

This is the core of the form. You mark one of three things: an arrest you are reporting, a conviction you are reporting, or a certification that you have no reportable history. New hires with nothing to report check the certification box and move to the signature.²

If you are reporting a legal event, provide the date, the specific offense, and the court jurisdiction. Match every detail — case numbers, offense descriptions, court names — to your official court paperwork. If your administrator receives a form that is incomplete or unclear, they are required to follow up and may ask you to resubmit.¹

Signature

Sign and date. Your signature acknowledges that the information is true and that false statements are punishable under 18 Pa.C.S. § 4904, Pennsylvania’s law on unsworn falsification to authorities.⁴ That warning is not decorative; people have been prosecuted for falsifying this form.

Submitting the Form Within 72 Hours

The 72-hour clock starts the moment the reportable arrest or conviction occurs, not when you get around to finding the form.³ Weekends and holidays do not pause it. An arrest late on a Friday means the deadline can fall on a Monday.

Deliver the completed form to your school administrator or whoever your district has designated to receive it, usually someone in human resources. Hand delivery is fastest and gives you the cleanest record. If you cannot hand it over in person, use a method that produces proof of delivery, such as certified mail with return receipt. If your employer later questions whether you met the deadline, that documentation is what protects you. The Department instructs administrators to accept the form at the address they specify when distributing it to employees.¹

New Hires: A Different Use of the Same Form

Prospective employees complete the PDE-6004 as part of onboarding rather than against a 72-hour deadline. You certify that you have not been convicted of a disqualifying offense, and the employer reviews the form alongside your standard background check results.²

Arrest vs. Conviction: Both Trigger the Deadline

You do not wait for the case to resolve. An arrest alone starts the 72-hour clock, even if the charges are later dropped.³ The form asks you to identify which you are reporting and to state the current status of the case. If you filed an arrest disclosure and the case later ends in a conviction, file an updated form so your employer’s records reflect the final disposition. The PDE-6004 is the standard mechanism for ongoing disclosure throughout your employment, not a one-time document.

What Your Employer Does After Receiving the Form

The administrator reviews the disclosure and decides what action, if any, is required. A permanently disqualifying conviction under Section 111(e) ends the person’s employment in the school. For an offense under Section 111(f.1), the administrator checks whether the applicable waiting period has run since the sentence expired.³

If an administrator has a reasonable belief that an employee was arrested or convicted of a reportable offense and did not file a PDE-6004, the administrator must immediately require new state and federal criminal background checks, at the employer’s expense. The same applies when an employee refuses to return the form.²

An administrator who believes an employee falsified the form is expected to report the matter to the local district attorney and to the Department of Education for potential professional discipline.¹ A copy of the completed form goes into your permanent personnel file.

Penalties for Not Reporting or Filing False Information

An employee who willfully fails to disclose a reportable arrest or conviction faces two consequences. The school district can impose discipline up to and including termination or denial of employment. The employee can also be criminally prosecuted under 18 Pa.C.S. § 4904.³

Filing a false statement on the PDE-6004, including omitting an offense you know should have been listed, is a misdemeanor of the third degree under § 4904(b), because the form itself carries the required notice that false statements are punishable.⁵ A third-degree misdemeanor in Pennsylvania carries up to one year of imprisonment and a fine of up to $2,000.⁶ Section 4904(d) also imposes a mandatory minimum fine of $1,000 for any conviction under that section.

The statute says discipline “up to and including” termination, so firing is not automatic and the administrator has discretion. Willful concealment, though, is treated very differently from a late but honest filing, and is far more likely to end in both termination and a criminal referral.

1
Pennsylvania Department of Education. Background Checks
2
Pennsylvania Department of Education. Acts, Laws and Regulations
3
Pennsylvania General Assembly. Pennsylvania Code Title 24 PS Education 1-111 – Criminal History of Employees and Prospective Employees
4
Pennsylvania Department of Education. PDE-6004 Arrest/Conviction Report and Certification Form
5
Pennsylvania General Assembly. Pennsylvania Consolidated Statutes Title 18 4904 – Unsworn Falsification to Authorities
6
Pennsylvania Code and Bulletin. 101 Pennsylvania Code 15.66 – Penalties for Offenses