Sexual Misconduct / Child Abuse Form

Required

State of New Jersey Sexual Misconduct/Child Abuse Disclosure Release

 
P.L. 2018, c. 5 Effective June 1, 2018
 
 
 
P.L. 2018, c. 5 concerns school employees and supplements chapter 6 of Title 18A of the New Jersey Statues. This law prohibits a school district, charter school, nonpublic school, or contracted service provider holding a contract with a school district, charter school, or nonpublic school (collectively referred to as “hiring entity”) from employing a person serving in a position which involves regular contact with students unless the hiring entity conducts a review of the employment history of the applicant by contacting former and current employers and requesting information regarding child abuse and sexual misconduct.
 
The applicant must submit this form for (1) all current employers and (2) to former employers within the last 20 years that were school entities or where the applicant was employed in a position that involved direct contact with children. The applicant will submit completed copies of this form to the hiring entity. The hiring entity will then submit this form to each of the current or former employers for completion of Section 2.
 
Applicant, please complete the information immediately below and Section 1 of this form and return it to the hiring entity. Please complete additional forms as necessary for each of your current and former employers for the last 20 years that were school entities or where you were employed in a position that involved direct contact with children.
 
 

TO: 

No applicable employment
Street, City, State, ZIP
The individual whose name appears herein has reported previous employment with your entity. As required by P.L. 2018, c. 5, please provide the information requested in Section 2 of this form within 20 days of receipt.

 

 

SECTION 1

Applicant Certification and Release

(to be completed by the applicant even if the applicant has no current or prior employment to disclose)

 

Applicant Namerequired
First Name
Middle (optional)
Last Name
Must contain a date in MM/DD/YYYY format

Have you (Applicant) ever:

Been the subject of any child abuse or sexual misconduct investigation by any employer, Statelicensing agency, law enforcement agency, or the Department of Children and Families (*unless theinvestigation resulted in a finding that the allegations were false or the alleged incident of childabuse or sexual misconduct was not substantiated)?required
Been disciplined, discharged, non-renewed, asked to resign from employment, resigned from orotherwise separated from any employment (1) while allegations of child abuse or sexual misconductwere pending or under investigation, or (2) due to an adjudication or finding of child abuse or sexualmisconduct?required
Had a license, professional license, or certificate suspended, surrendered, or revoked (1) whileallegations of child abuse or sexual misconduct were pending or under investigation, or (2) due to anadjudication or finding of child abuse or sexual misconduct?required

 

By signing this form, I (the applicant) certify under penalty of law that the statements made in this form are true, correct, and complete. I understand that willfully providing false information or willfully failing to disclose information required in Section 1 of this form, as required by N.J.S.A. 18A:6-7.7, may subject me to discipline up to, and including, termination or denial of employment; may be a violation of N.J.S.A. 2C:28-3; and may subject me to a civil penalty of not more than $500, which shall be collected in proceedings in accordance with the “Penalty Enforcement Law of 1999,” P.L. 1999, c. 274.

By signing this form, I also hereby authorize the above-named employer to disclose the information requested in Section 2 and release related records pertaining to the disclosures identified in SECTION 2. I understand that pursuant to N.J.S.A. 18A:6-7.7, the above-named employer is released from liability that may arise of the disclosure or release of records.

Please type name to sign
Must contain a date in MM/DD/YYYY format

 

 

SECTION 2

 

Current/Former Employer Verification

(to be completed by the applicant’s current employer(s) and all former employers that were school entities or former employers in which the applicant had direct contact with children). Please complete the information below and return this form to the hiring entity.

N.J.S.A. 18A:6-7.7(b) provides that a hiring entity shall not employ for pay or contract for the paid services of any person in a position that involved regular contact with students unless the hiring entity conducts a review of the employment history of applicant by contacting those employers listed by the applicant under the provisions of N.J.S.A. 18A:6-7.7(a) and collecting the information requested below.

 

Must contain a date in MM/DD/YYYY format

 

To the best of your knowledge, has the applicant ever:

 

Been the subject of any child abuse or sexual misconduct investigation by any employer, Statelicensing agency, law enforcement agency, or the Department of Children and Families (*unless theinvestigation resulted in a finding that the allegations were false or the alleged incident of childabuse or sexual misconduct was not substantiated)?
Been disciplined, discharged, non-renewed, asked to resign from employment, resigned from orotherwise separated from any employment while allegations of child abuse or sexual misconduct werepending or under investigation, or due to an adjudication or finding of child abuse or sexual misconduct?
Had a license, professional license, or certificate suspended, surrendered, or revoked while allegationsof child abuse or sexual misconduct were pending or under investigation, or due to an adjudication orfinding of child abuse or sexual misconduct?
Please type name to sign
Must contain a date in MM/DD/YYYY format

 

If a current or former employer responds to any Section 2 disclosure in the affirmative, the hiring entity may request additional information regarding the disclosure by requesting that the current or former employer complete the Sexual Misconduct/Child Abuse Disclosure Information Request form within 20 days and attach additional information, including the initial complaint and final report, if any, regarding the incident of child abuse or sexual misconduct. Pursuant to N.J.S.A. 18A:6-7.11, a current or former employer that provides information or records about a current or former employee or applicant shall be immune from criminal and civil liability for the disclosure of the information, unless the information or records provided were knowingly false. The immunity shall be in addition to, and not in limitation of, any other immunity provided by law.

The failure of a current or former employer to provide the information requested in Section 2 within the 20-day timeframe required by N.J.S.A. 18A:6-7.9 may be grounds for the automatic disqualification of an applicant from employment with the hiring entity. The hiring entity shall not be liable for any claims brought by an applicant who is not offered employment or whose employment is terminated: (1) because of any information received by the hiring entity from an employer pursuant to N.J.S.A. 18A:6-7.7; or (2) due to the inability of the hiring entity to conduct a full review of the applicant’s employment history pursuant to N.J.S.A. 18A:6-7.7.

 

Return all completed information to:
 
 
 

 

 

State of New Jersey

Sexual Misconduct/Child Abuse Disclosure Release Instructions

P.L. 2018, C. 5

Effective June 1, 2018

 

Instructions

This standardized form has been developed by the New Jersey Department of Education, pursuant to P.L. 2018, c. 5, to

be used by hiring entities and by applicants, who would be employed by, or in, a school, in a position involving regular contact with students. This form satisfies the statutory requirement to provide information related to child abuse or sexual misconduct. An applicant who would be employed by or in a school in a position having regular contact with students must provide the information requested in Section 1 of this form and sign the authorization for the disclosure by the applicant’s current and former employers of the information requested in Section 2 of this form.

The applicant shall complete one form for the applicant’s current employer(s) and separate forms for each of the applicant’s former employers for the last 20 years that were school entities or where the applicant was employed in a position having direct contact with children. The applicant will submit this form in its entirety, with the information on Page 1 and Section 1 completed, to the hiring entity. The applicant must also authorize, by signature, the release of information regarding child abuse and/or sexual misconduct from the current and/or former employers to the hiring entity. The hiring entity is prohibited from hiring an applicant for a position involving regular contact with students if the applicant does not provide the information and authorization required by law.

Upon completion by the applicant, the hiring entity shall submit the form to the applicant’s current and former employers to complete Section 2 of this form. A hiring entity may not employ an applicant who does not provide the required information for a position involving regular contact with students.

If a current and/or former employer responds to any Section 2 disclosure in the affirmative, the hiring entity may request additional information regarding the disclosure by requesting that the current and/or former employer complete the Sexual Misconduct/Child Abuse Disclosure Information Request form and attach additional information, including the initial complaint and final report, if any, regarding the incident of child abuse or sexual misconduct. Upon providing documentation due to an affirmative response, every measure should be taken to ensure student privacy and confidentiality. All student identifiers should be redacted prior to release.

Relevant Statutory Definitions Pursuant to N.J.S.A. 18A:6-7.6

Child abuse is defined as any conduct that falls under the purview and reporting requirements of P.L. 1971, c. 437 (N.J.S.A. 9:6-8.8 et seq.) and is directed toward or against a child or student, regardless of the age of the child or student.

Sexual misconduct is defined as any verbal, nonverbal, written, or electronic communication, or any other act directed toward or with a student that is designed to establish a sexual relationship with the student, including a sexual invitation, dating or soliciting a date, engaging in sexual dialogue, making sexually suggestive comments, self-disclosure or physical exposure of a sexual or erotic nature, and any other sexual, indecent or erotic contact with a student.

ADDITIONAL INFORMATION

Per N.J.S.A. 18A:6-7.9, a hiring entity shall have the right to immediately terminate an individual’s employment or rescind an offer of employment if: (1) the applicant is offered employment or commences employment with the hiring entity following the effective date of this act; and (2) information regarding the applicant’s history of sexual misconduct or child abuse is subsequently discovered or obtained by the employer that the employer determines disqualifies the applicant or employee from employment with the hiring entity. The termination of employment pursuant to N.J.S.A.18A:6-7.9 shall not be subject to any grievance or appeals procedures or tenure proceedings pursuant to any collective bargaining agreement or negotiated agreement or any law, rule, or regulation.

Per N.J.S.A. 18A:6-7.10, after reviewing the information disclosed in Section 1 and/or Section 2 of this form, and finding an affirmative response to any of the inquiries, the hiring entity, prior to determining to continue with the applicant’s job application process, shall make further inquiries of the applicant’s current or former employer to ascertain additional details regarding the matter disclosed. The hiring entity should use its discretion, consistent with statute, in the event that a current/former employer is no longer in operation or fails to respond to Section 2 of this form.

The hiring entity may employ or contract with an applicant on a provisional basis for a period not to exceed 90 days pending the hiring entity or independent contractor’s review of information received related to Section 1 and/or Section 2 of this form, provided that all of the following conditions are satisfied: (1) the applicant has complied with N.J.S.A. 18A:6-7.7; (2) the hiring entity has no knowledge or information pertaining to the applicant that the applicant is required to disclose pursuant to N.J.S.A. 18A:6-7.7(a)(3); and (3) the hiring entity determines that special or emergent circumstances exist that justify the temporary employment of the applicant.

The sexual misconduct or child abuse disclosures articulated herein are required in addition to satisfying any pre-existing requirements for employment in a school, including a criminal history review, pursuant to N.J.S.A. 18A:6-7.1 and N.J.A.C. 6A:9B-4.2.

Open Public Records Act

Pursuant to N.J.S.A. 18A:6-7.11, information received by a hiring entity under this Act shall not be deemed a public record under P.L. 1963, c. 73 or the common law concerning access to public records.

Immunity

Pursuant to N.J.S.A. 18A:6-7.11, a current or former employer that provides information or records about a current or former employee or applicant shall be immune from criminal and civil liability for the disclosure of the information, unless the information or records provided were knowingly false. The immunity shall be in addition to, and not in limitation of, any other immunity provided by law.

Contact

For more information, please contact the County Office of Education for the hiring entity.

Please complete the security verification below.