Act 24 - Arrest/Conviction Report and Cert. Form

Last Updated: 10/16/2019 3:47 PM

The PDE 6004 form was updated as of August 2012 (see below). Please review the form and the changes in the list of offenses that must be reported on page 3. If any of the offences pertain to you now or in the future, you must complete the form and hand it in to the HR Director within 72 hours of any arrest or conviction of an offense listed.


ACT 24 - ACT 82 2012