Form Cf 1649 - Affidavit Of Good Moral Character - Florida Dept.of Children And Families
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3AFFIDAVIT OF GOOD MORAL CHARACTER
Clear
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:
Go To Page 3 (signature page)
Relating to:
Section 393.135
sexual misconduct with certain developmentally disabled clients and reporting of such sexual misconduct
Section 394.4593
sexual misconduct with certain mental health patients and reporting of such sexual misconduct
Section 415.111
adult abuse, neglect, or exploitation of aged persons or disabled adults or failure to report of such abuse
Section 741.28
criminal offenses that constitute domestic violence, whether committed in Florida or another jurisdiction
Section 777.04
attempts, solicitation, and conspiracy to commit an offense listed in this subsection
Section 782.04
murder
Section 782.07
manslaughter, aggravated manslaughter of an elderly person or disabled adult, or aggravated manslaughter
of a child
Section 782.071
vehicular homicide
Section 782.09
killing an unborn child by injury to the mother
Chapter 784
assault, battery, and culpable negligence, if the offense was a felony
Section 784.011
assault, if the victim of offense was a minor
Section 784.03
battery, if the victim of offense was a minor
Section 787.01
kidnapping
Section 787.02
false imprisonment
Section 787.025
luring or enticing a child
Section 787.04(2)
taking, enticing, or removing a child beyond the state limits with criminal intent pending custody proceeding
Section 787.04(3)
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
Section 790.115(1)
exhibiting firearms or weapons within 1,000 feet of a school
Section 790.115(2)(b)
possessing an electric weapon or device, destructive device, or other weapon on school property
Section 794.011
sexual battery
Former Section 794.041
prohibited acts of persons in familial or custodial authority
Section 794.05
unlawful sexual activity with certain minors
Chapter 796
prostitution
Section 798.02
lewd and lascivious behavior
Chapter 800
lewdness and indecent exposure
Section 806.01
arson
Section 810.02
burglary
Section 810.14
voyeurism, if the offense is a felony
Section 810.145
video voyeurism, if the offense is a felony
Chapter 812
theft and/or robbery and related crimes, if a felony offense
Section 817.563
fraudulent sale of controlled substances, if the offense was a felony
Section 825.102
abuse, aggravated abuse, or neglect of an elderly person or disabled adult
Section 825.1025
lewd or lascivious offenses committed upon or in the presence of an elderly person or disabled adult
825.103
Section
exploitation of disabled adults or elderly persons, if the offense was a felony
Section 826.04
incest
Section 827.03
child abuse, aggravated child abuse, or neglect of a child
Section 827.04
contributing to the delinquency or dependency of a child
Former Section 827.05
negligent treatment of children
Section 827.071
sexual performance by a child
CONTINUED ON NEXT PAGE
Page 1 of 3
CF 1649, PDF 01/2015
[65C-13.023 and 65C-13.025, F.A.C.]
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