Required Clearance Checks Form (Children & Youth Workers) - Ebic (Elizabethtown Bic Church), Pa

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R
C
C
F
EQUIRED
LEARANCE
HECKS
ORM
Children & Youth Workers
P
Y
N
________________________________________
RINT
OUR
AME
All children and youth workers, both volunteer (ages 18 and older) and paid (age 14 and older), are required to complete
the following clearances. Costs incurred may be reimbursed by submitting receipts to EBIC. Instructions for completing
current clearances are below:
1. PA S
P
C
R
C
TATE
OLICE
RIMINAL
ECORD
HECK
epatch.state.pa.us
W
:
EBSITE
C
: $8
FREE
OST
(for paid workers)
(for volunteers)
An instant response will be provided if there is no record
Submit a printed copy of your PA S
P
R
C
R
C
TATE
OLICE
ESPONSE FOR
RIMINAL
ECORD
HECK
2. PA D
H
S
C
A
H
C
EPARTMENT OF
UMAN
ERVICES
HILD
BUSE
ISTORY
LEARANCE
W
:
EBSITE
C
: $8
FREE
OST
(for paid workers)
(for volunteers)
Create an account and submit your request electronically. It is helpful to collect the following information
prior to beginning your submission:
1. Addresses where you have previously lived
2. Names of all individuals with whom you have lived to include parents, guardians, siblings,
spouses, etc.
3. Any previous names you have used or have been known by
Results will be emailed/mailed to you within 14 days of submission.
Submit a printed copy of your PA D
H
S
C
A
H
C
EPARTMENT OF
UMAN
ERVICES
HILD
BUSE
ISTORY
LEARANCE
3. PA R
OR F
C
H
B
C
ESIDENCY
EDERAL
RIMINAL
ISTORY
ACKGROUND
HECK
Please check ONE(1) of the appropriate boxes and complete instructions of that section.
I am submitting to be a volunteer ONLY at EBIC. I have lived in Pennsylvania during the entirety of the past 10
consecutive years. I have not been convicted of a felony nor a sex crime over the past five years.
S
________________________________________
D
________________
IGNATURE
ATE
I have lived OUTSIDE of Pennsylvania at some point during the last 10 years OR I will be a paid employee of EBIC.
Complete the fingerprint based Federal (FBI) Criminal History Background Check:
1. Register at:
following the steps listed under Registration
2. Print your registration confirmation & take it along with your driver’s license to one of these locations
to be fingerprinted:
Elizabethtown Location
L
L
ANCASTER
OCATION
E-town Public Library
UPS Store #3413
10 South Market Street
Stone Mill Plaza
Elizabethtown, PA 17022
1390 Columbia Avenue
(717) 367-7467
Lancaster PA 17603
M-Th 9
- 8
AM
PM
(717)299-9269
FRI 9
-1
/ SAT 9
- 4
AM
PM
AM
PM
M–F 9
– 5
/ SAT 9
–3
AM
PM
AM
PM
3. The result of your federal criminal history background check will be mailed to you within 7-10 days.
Submit a copy of the results.
ALL PAPERWORK should be returned to L
L
(O
M
) by either of these methods:
AURA
ANE
FFICE
ANAGER
1. A sealed envelope to the church office
Completed/scanned to
2.
Q
? Call or email the church office (717.367.2615 / )
UESTIONS
Forms may also be mailed to EBIC Elizabethtown BIC Church, 996 E High St, Elizabethtown PA 17022
10/22/2015
K:\policies\Children and Youth Protection Policy\Background Forms_Checks\3 EBIC Required Clearance Checks Form.docx

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