Educational Employer Disclosure Form Applicant Release Pa 16-67 - sde ct 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Section 1, where you will enter your name, any former names, and your current address. Ensure all information is accurate for proper identification.
3. Next, provide approximate dates of employment and the position held with each employer listed in Section 3. This information is crucial for verification purposes.
4. In Section 2, the prospective employer's details must be filled out. Include their name, address, contact person, and their telephone number or email address.
5. Section 3 is for the current/former employer to complete. They will need to provide their name, date of receipt of this notice, and employment dates of the applicant.
6. Finally, answer the yes/no questions regarding allegations or disciplinary actions. Ensure that these responses are truthful as they are significant for your application.

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