lnlk n Essay

Submitted By javila6
Words: 1472
Pages: 6

State of Florida

County of ______________________

Before me this day personally appeared _________________________________________ who, being duly
(Applicant’s/Employee’s Name)

sworn, deposes and says:
As an applicant for employment with, an employee of, a volunteer for, or an applicant to volunteer with
________________________________________________, I affirm and attest under penalty of perjury that I meet the moral character requirements for employment, as required by the Florida Statutes and rules, in that:
I have not been arrested with disposition pending or found guilty of, regardless of adjudication, or entered a plea of nolo contender or guilty to or have been adjudicated delinquent and the record has not been sealed or expunged for, any offense prohibited under any of the following provisions of the Florida Statutes or under any similar statute of another jurisdiction for any of the offenses listed below:
Relating to:
Section 393.135
Section 394.4593
Section 415.111
Section 741.28
Section 782.04
Section 782.07
Section 782.071
Section 782.09
Chapter 784
Section 784.011
Section 784.03
Section 787.01
Section 787.02
Section 787.025
Section 787.04(2)
Section 787.04(3)
Section 790.115(1)
Section 790.115(2) (b)
Section 794.011
Former Section 794.041
Section 794.05
Chapter 796
Section 798.02
Chapter 800
Section 806.01
Section 810.02
Section 810.14
Section 810.145
Chapter 812
Section 817.563
Section 825.102
Section 825.1025
Section 825.103
Section 826.04
Section 827.03
Section 827.04
Former Section 827.05
Section 827.071
Section 843.01

sexual misconduct with certain developmentally disabled clients and reporting of such sexual misconduct sexual misconduct with certain mental health patients and reporting of such sexual misconduct adult abuse, neglect, or exploitation of aged persons or disabled adults or failure to report of such abuse criminal offenses that constitute domestic violence, whether committed in Florida or another jurisdiction murder manslaughter, aggravated manslaughter of an elderly person or disabled adult, or aggravated manslaughter of a child vehicular homicide killing an unborn quick child by injury to the mother assault, battery, and culpable negligence, if the offense was a felony assault, if the victim of offense was a minor battery, if the victim of offense was a minor kidnapping false imprisonment luring or enticing a child taking, enticing, or removing a child beyond the state limits with criminal intent pending custody proceeding carrying a child beyond the state lines with criminal intent to avoid producing a child at a custody hearing or delivering the child to the designated person exhibiting firearms or weapons within 1,000 feet of a school possessing an electric weapon or device, destructive device, or other weapon on school property sexual battery prohibited acts of persons in familial or custodial authority unlawful sexual activity with certain minors prostitution lewd and lascivious behavior lewdness and indecent exposure arson burglary voyeurism, if the offense is a felony video voyeurism, if the offense is a felony theft and/or robbery and related crimes, if a felony offense fraudulent sale of controlled substances, if the offense was a felony abuse, aggravated abuse, or neglect of an elderly person or disabled adult lewd or lascivious offenses committed upon or in the presence of an elderly person or disabled adult exploitation of disabled adults or elderly persons, if the offense was a felony incest child abuse, aggravated child abuse, or neglect of a child contributing to the delinquency or dependency of a child negligent treatment of children sexual performance by a child resisting arrest with violence

CF 1649, Aug 2010 (Obsoletes previous editions which may not be used)

Page 1 of 3

Section 843.025
Section 843.12