Transcription of Pennsylvania Child Abuse History Clearance - witf.org
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Pennsylvania Child Abuse History Clearance - witf.org
Pennsylvania Child Abuse History CLEARANCECOMPLETE SECTION 1 ONLY. Print clearly in ink. Enclose $ money order ONLY, payable to DEPARTMENT OF PUBLIC WELFARE. DO NOT send cash or personal to CHILDLINE AND Abuse REGISTRY, DEPARTMENT OF PUBLIC WELFARE, BOX 8170 HARRISBURG, PA 17105-8170 APPLICATIONS THAT ARE INCOMPLETE, ILLEGIBLE OR RECEIVED WITHOUT FEE WILL BE RETURNED UNPROCESSED. IF YOU HAVE QUESTIONS CALL 717-783-6211, OR (TOLL FREE) USE ONLYDATE RECEIVED BY CHILDLINESECTION IAPPLICANT IDENTIFICATIONIN THIS SPACE PRINT APPLICANT S FULL NAME AND ADDRESS (DO NOT USE INITIALS)NAMESTREETCITY, STATEZIP CODESOCIAL SECURITY NUMBERAGEDATE OF BIRTHDAYTIME PHONE M p FCOUNTY YOU LIVE INDisclosure of your Social Security number is voluntary.
cy 113 (uf) 6/11. voluntary certification for child care services pennsylvania child abuse history clearance pennsylvania state police clearance
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