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CF 1649, Nov 2020 [65C-45.001, F.A.C.]
Attestation under penalty of perjury is required by s. 435.05, F.S.
Page 1 of 3
AFFIDAVIT OF GOOD MORAL CHARACTER
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 contendere 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
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,