Florida Home For Special Services Attestation of Compliance with Background Screening Requirements

Form Template

This form may be used by all employees to comply with the attestation requirements of Florida Statutes, which state that every employee required to undergo Level 2 background screening must attest to meeting the requirements for qualifying for employment and agree to inform the employer immediately if arrested for any of the disqualifying offenses while employed by the employer.

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Employees must also agree to comply with the proof of screening within the previous 5 years which requires proof of compliance with level 2 screening standards that have been screened through the Care Provider Background Screening Clearinghouse or screened within the previous 5 years by the Agency, Department of Health, Department of Elder Affairs, the Agency for Persons with Disabilities, Department of Children and Families, or the Department of Financial Services for an applicant for a certificate of authority to operate a continuing care retirement community if that agency is not currently implemented in the Care Provider Background Screening Clearinghouse. Applicants can easily comply by signing the Florida Home For Special Services Attestation of Compliance with Background Screening Requirements app.

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