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Click ‘Get Form’ to open the Act 168 document in the editor.
Begin with SECTION 1, where you will enter your personal information including your name, any former names, date of birth, and the last four digits of your Social Security Number.
Provide details about your current and former employment. This includes the name of the employer, position held, and approximate dates of employment.
Answer the questions regarding any past investigations or disciplinary actions related to abuse or sexual misconduct by selecting 'Yes' or 'No'.
Sign and date the form to certify that all information provided is accurate and complete.
Once completed, submit SECTION 1 to your current employer for them to fill out SECTION 2.
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