Arrest Reporting .gov
Arrest Reporting TemplateConsistent with the Reporting Employees Charged with Criminal Conduct memo dated January 10, 2007, from the Deputy Secretary for Human Resources and Management, please use this template when reporting employee arrest information to the Office of Administration. Once the template is completed, please save this template as a Microsoft Word document and send an electronic copy to the OA, Investigations mailbox (RA-Investigations@state.pa.us).Employee SSN (last 4): FORMTEXT ???? Personnel Number: FORMTEXT ?????Agency: FORMTEXT ?????Job Name: FORMTEXT ?????Employee First Name: FORMTEXT ?????Employee Last Name: FORMTEXT ?????Arrest Date: FORMTEXT ????? (M/D/YYYY)Charge: FORMTEXT ?????Employment Status: FORMTEXT ?????Offense Level: FORMTEXT ?????Disposition: FORMTEXT ?????Agency Action Taken: FORMDROPDOWN Agency Contact: FORMTEXT ?????Additional Comments: FORMTEXT ????? ................
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