Form Cf 1649 - Affidavit Of Good Moral Character - Florida Dept.of Children And Families Page 2
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3Section 843.01
resisting arrest with violence
Section 843.025
depriving a law enforcement, correctional, or correctional probation officer means of protection or
communication
Section 843.12
aiding in an escape
Section 843.13
aiding in the escape of juvenile inmates in correctional institution
Chapter 847
obscene literature
Section 874.05(1)
encouraging or recruiting another to join a criminal gang
Chapter 893
drug abuse prevention and control only if the offense was a felony or if any other person involved in the
offense was a minor
Section 916.1075
sexual misconduct with certain forensic clients and reporting of such sexual conduct
Section 944.35(3)
inflicting cruel or inhuman treatment on an inmate resulting in great bodily harm
Section 944.40
escape
Section 944.46
harboring, concealing, or aiding an escaped prisoner
Section 944.47
introduction of contraband into a correctional facility
Section 985.701
sexual misconduct in juvenile justice programs
Section 985.711
contraband introduced into detention facilities
THE FOLLOWING APPLIES ONLY TO THOSE APPLICANTS FOR MENTAL HEALTH POSITIONS
In addition to the Chapter 435, F.S., listed offenses, the following offenses are also applicable for “Mental
Health Personnel” screened pursuant to section 394.4572, F.S., defined as “program directors, professional
clinicians, staff members, or volunteers working in a public or private mental health program or facility who
have direct contact with individuals held for examination or admitted for mental health treatment. The
additional offenses apply only to “Mental Health Personnel” as determined pursuant to Section
408.809, F.S. as listed below:
Relating to:
Chapter 408
felony offenses contained in Chapter 408
Section 408.8065(3)
offers service or skilled service without valid license when licensure is required, or knowingly files a false or
misleading license or license renewal application, or submits false or misleading information related to
application
Section 409.920
Medicaid provider fraud
Section 409.9201
Medicaid fraud
Section 777.04
attempts, solicitation, and conspiracy to commit an offense listed in this subsection
Section 817.034
fraudulent acts through mail, wire, radio, electromagnetic, photoelectronic, or photooptical systems
Section 817.234
false and fraudulent insurance claims
Section 817.481
obtaining goods by using a 236 false or expired credit card or other credit device, if the offense was a felony
Section 817.50
fraudulently obtaining goods or services from a health care provider
Section 817.505
patient brokering
Section 817.568
criminal use of personal identification information
Section 817.60
obtaining a credit card through fraudulent means
Section 817.61
fraudulent use of credit cards, if the offense was a felony
Section 831.01
forgery
Section 831.02
uttering forged instruments
Section 831.07
forging bank bills, checks, drafts or promissory notes
Section 831.09
uttering forged bank bills, checks, drafts, or promissory notes
Section 831.30
fraud in obtaining medicinal drugs
Section 831.31
the sale, manufacture, delivery, or possession with the intent to sell, manufacture, deliver any counterfeit
controlled substance, if the offense was a felony.
Section 895.03
racketeering and collection of unlawful debts
Section 896.101
the Florida Money 263 Laundering Act
I also affirm that I have not been designated as a sexual predator pursuant to s. 775.21, F.S.; a career offender
pursuant to s. 775.261, F.S.; or a sexual offender pursuant to s. 943.0435, F.S., unless the requirement to
register as a sexual offender has been removed pursuant to s. 943.04354, F.S.
I understand that I must acknowledge the existence of any applicable criminal record relating to the above lists
of offenses including those under any similar statute of another jurisdiction, regardless of whether or not those
records have been sealed or expunged. Further, I understand that, while employed or volunteering at
________________________________________________ in any position that requires background
screening as a condition of employment, I must immediately notify my supervisor/employer of any arrest and
CONTINUED ON NEXT PAGE
Page 2 of 3
CF 1649, PDF 01/2015
[65C-13.023 and 65C-13.025, F.A.C.]
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