ACT 168 Verification Form(s)


You must complete a form for every employer whom you worked for that meets any of the above criteria. Please note that you may need to make additional copies of the attached ACT 168 Verification Form. If you are currently unemployed and have no previous employers that fit the above criteria mark the “not applicable” box and complete Section 1.

Complete and submit an ACT 168 form for the following:

 Your current employer(s)

 Your former employer(s) that were school entities; and

 Your former employer(s) where you were employed in a position where you had direct contact with children. Direct contact with children means, “The possibility of care, supervision guidance or control of children or routine interaction with children.”

1)    First, complete the top section with the name of your current/former employer and their contact information. (Please include the employer’s fax number or email address and telephone number. If this is not complete we will return the form to you and this will delay the date you can begin work.)

2)    Next, complete Section 1, which includes a checklist of three statements in addition to requiring your signature and date on Page 2. DO NOT complete Section 2.

3)DO NOT send the form to your current/former employer(s). State law requires that Pittsburgh Public Schools sends the ACT 168 forms to all of your relevant employers. Each employer will have up to 20 days to complete and return the form. You are not permitted to begin work with the District until the ACT 168 form(s) are returned from all of your employers or 21 days has passed from the date the report was sent to your employers.

4)    Finally, return the form(s) to the HR department through fax or email immediately. If the form(s) are returned by email please save the ACT 168 form(s) as “Your First and Last Name – ACT 168”  and in the subject line type the words “Act 168”

2. Act 168 Verification Form.pdf, 79.75 KB; (Last Modified on March 8, 2022)