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. It is sought under 23 6336(a)(1) (relating to Information in statewide central register), 6344 (relating to Information relating to prospective Child care personnel), (relating to Information relating to family day-care home residents), and (relating to Information relating to other persons having contact with children).
PENNSYLVANIA CHILD ABUSE HISTORY CLEARANCE. COMPLETE SECTION 1 ONLY. Print clearly in ink. Enclose $10.00 money order ONLY, payable to DEPARTMENT OF PUBLIC WELFARE.
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