Prospective candidates seeking employment at Allegheny Children's Initiative are required
to produce 3 different criminal history background clearances at the time of their interview. The three clearances,
which must all be
current (i.e. dated within the past 1 year), include:
1.) Pennsylvania Child Abuse History Clearance (Act 33)
2.) Pennsylvania State Police Request for Criminal Records Check (Act 34) -and-
3.) FBI Criminal Background Check (Act 73)
How do I obtain these clearances?
Pennsylvania Child Abuse History Clearance (Act 33)
- Takes approx. 3 weeks.
- Download the Pennsylvania Child Abuse History Clearance form (CY-113) (Adobe Reader required):
http://www.dpw.state.pa.us/Resources/Documents/Pdf/FillInForms/DPWchildabuse.pdf
- Complete Section I on that form:
- Fill in all requested information (neatly/legibly)
- Check off "Child Care" as the PURPOSE OF CLEARANCE
- List all addresses at which you lived since 1975 (to the best of your recollection)
- List all persons with whom you lived since 1975 (to the best of your recollection)
- NOTE: If you are currently 54 or younger, you will need to include your parent(s) and/or guardian(s). Failure to
do so will probably result in your application being returned to you unprocessed!!
- Obtain a $10.00 Money Order, payable to DEPARTMENT OF PUBLIC WELFARE (Do not send cash or check).
- Send the completed form/money order to:
Childline and Abuse Registry
Department of Public Welfare
P.O. Box 8170
Harrisburg, Pa 17105-8170
Pennsylvania State Police Request for Criminal Records Check (Act 34)
Online Method (Pennsylvania State Police Website)
- Results are returned immediately (if no record exists). Can take up to 5 weeks otherwise.
- Go to the ePatch website (Credit card required):
https://epatch.state.pa.us/
- Click Submit a New Record Check under the Credit Card Users heading.
- Read and accept the terms, and continue to follow the instructions to submit your background check.
- If no record exists, you can immediately print out your clearance certificate.
Mail-in Method (Using Form SP4-164)
- Takes approx. 4-5 weeks.
- Download the Request for Criminal Records Check form (SP4-164):
Microsoft Word version (fill-in form):
https://epatch.state.pa.us/help/sp4164.doc
Adobe Reader version (not a fill-in form):
http://www.dpw.state.pa.us/Resources/Documents/Pdf/FillInForms/statepolice-bkgd.pdf
- From the top, down, complete the following:
- Date of Request
- Requester Name/Address (this is you)
- Contact Telephone Number (your phone number)
- Requester Identification (Check the first box, and fill in all requested information)
- Reason For Request (Check "Employment" and "Child Care")
- Obtain a $10.00 Certified Check -or- Money Order, payable to COMMONWEALTH OF PENNSYLVANIA (Do not send cash or personal check).
- Send the completed form/certified check or money order to:
Pennsylvania State Police
Central Repository – 164
1800 Elmerton Avenue
Harrisburg, Pa 17110-9758
FBI Criminal Background Check (Act 73)
- Takes approx. 1-3 weeks.
- Register for fingerprinting online at the Cogent website:
https://www.pa.cogentid.com/index_dpw.htm
- Under the "Registration" section, click on "Register Online" to open the online registration form
- Select "Applicant Credit Card" or "Applicant Money Order" at the top of the online form
- Select "Employment with a significant likelihood..." as the Reason Fingerprinted
- Then complete all of the required Personal Information and click "Next" when finished
- Print the confirmation page as you will need the confirmation or registration number when you go to get fingerprinted
- Get to one of the designated locations to get fingerprinted. Fingerprint locations, their hours of operation, and a list of what you'll need to take with you can be found under the "Print Site Locations" section of the Cogent website.
Where can I find additional information?
