Moon Run VFC - PA Child Abuse Clearance
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Email *
Entry Type *
First Name *
As it appears on your State Issued ID
Middle Name
If applicable (As it appears on your State Issued ID)
Last Name *
As it appears on your State Issued ID
Suffix
If applicable (As it appears on your State Issued ID)
Date of Birth *
MM
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DD
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YYYY
Age *
SSN
You are consenting to a verification of your Social Security number through the Social Security Administration. Your Social Security number is also being sought under 23 Pa.C.S. §§ 6336(a)(1) (relating to Information in statewide central register), 6344 (relating to Information relating to prospective child care personnel), 6344.1 (relating to Information relating to family day-care home residents), and 6344.2 (relating to Information relating to other persons having contact with children). The department will use your Social Security number to search the statewide central register to determine whether you are listed as the perpetrator in an indicated or founded report of child abuse. Providing your Social Security number may enable the Department to expedite the review of your request for a clearance certificate.  If you do not provide your Social Security number additional levels of identity verification may be required by ChildLine staff, reducing the chance of automatic processing of your request.  However, please note that disclosure of your Social Security number is voluntary and therefore, if you do not consent to having your Social Security number verified or used for checking your child abuse history, we will still process your request without your Social Security number.
Gender *
Home Telephone Number
If applicable
Work Telephone Number
If applicable
Mobile Telephone Number
If applicable
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This form was created inside of Moon Run Volunteer Fire Company. Report Abuse