Arrest/Conviction Report and Certification Form (PDE-6004)
Act 24 of 2011 and Act 82 of 2012 require school district employees to self-report an arrest by completing the Arrest/Conviction Report and Certification Form (PDE-6004) within seventy-two (72) hours. This completed form must be returned to the Human Resources Department - see form below.
These are consequences listed on the PDE-6004 Form:
§4904. Unsworn falsification to authorities.
(a) In general.--A person commits a misdemeanor of the second degree if, with intent to mislead a public servant in performing his official function, he:
(1) makes any written false statement which he does not believe to be true;
(2) submits or invites reliance on any writing which he knows to be forged, altered or otherwise lacking in authenticity; or
(3) submits or invites reliance on any sample, specimen, map, boundary mark, or other object which he knows to be false.
(b) Statements "under penalty".--A person commits a misdemeanor of the third degree if he makes a written false statement which he does not believe to be true, on or pursuant to a form bearing notice, authorized by law, to the effect that false statements made therein are punishable.
(c) Perjury provisions applicable.--Section 4902(c) through (f) of this title (relating to perjury) applies to this section.
(d) Penalty.--In addition to any other penalty that may be imposed, a person convicted under this section shall be sentenced to pay a fine of at least $1,000.