00217712420010101
PENNSYLVANIA CHILD ABUSE
HISTORY CERTIFICATION
RITAMARIE JIMENEZ CERTIFICATION ID: 09TLPLZ7OH
3816 TARPLEY DRIVE CERTIFICATION PURPOSE: EMPLOYMENT
YORK, PA 17402
VERIFICATION DATE: 7/17/2016
SOCIAL SECURITY #: XXX-XX-2159
DATE OF BIRTH: 8/24/1977
The above named person has applied for a Pennsylvania Child Abuse History
Certification pursuant to 23 Pa. C.S., Chapter 63 related to the Child Protective
Services Law. NO RECORDS EXIST in the Pennsylvania Department of Human
Services' Statewide database listing the applicant as a perpetrator of an Indicated or
Founded report of child abuse.
Applicants are required to show the Administrator the results of their
Child Abuse History Certification. Administrators are required to keep a
copy of this Child Abuse History Certification on file. Any person altering
the contents of this document may be subject to civil, criminal or
administrative action.
ISSUED BY Commonwealth of Pennsylvania
Department of Human Services
CHILDLINE AND ABUSE REGISTRY
ChildLine Verification Unit
P.O. Box 8170
Harrisburg, PA 17105-8170
1-877-371-5422
04639O CY893O - 6/00