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Apply for Exemption From Disqualification

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Requestor Information


Facility / Certification Board Information


Three years or more have passed since I have been released from prison, parole or other criminal-related supervision that had been court ordered for a disqualifying felony criminal offense.
Any and all outstanding court-ordered costs or fees associated with my criminal history have been paid in full and I do not owe restitution, public defender or other court costs.
I am not designated as a sexual predator, sexual offender, or career offender.
I am formally requesting that the Department, in accordance with the provisions of Chapters 393, 408 and 435, Florida Statutes, provide me with an Exemption Review.
I understand that I must provide clear and convincing evidence to support a reasonable belief that I am of good moral character and that I pose no danger to the health or safety of children, persons with developmental disabilities, or vulnerable adults.
I understand that the decision of the Department of Children and Families or the Agency for Persons with Disabilities regarding this Exemption may be contested through a hearing under the provisions of Chapter 120, F.S.
I understand any person that knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor of the second degree.
By clicking submit you agree you are electronically signing and dating this form and submitting this form electronically to the department.