DOEA/OPPG Form 002 "Professional Guardian Employee Registration Form" - Florida

What Is DOEA/OPPG Form 002?

This is a legal form that was released by the Florida Department of Elder Affairs - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 1, 2017;
  • The latest edition provided by the Florida Department of Elder Affairs;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of DOEA/OPPG Form 002 by clicking the link below or browse more documents and templates provided by the Florida Department of Elder Affairs.

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Download DOEA/OPPG Form 002 "Professional Guardian Employee Registration Form" - Florida

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OFFICE OF PUBLIC AND PROFESSIONAL GUARDIANS
Professional Guardian Employee Registration Form
This Professional Guardian Employee Form shall be included in the Professional Guardian file of:
SECTION A.
PROFESSIONAL GUARDIAN EMPLOYEE INFORMATION
Mr._ Ms._ Last Name:
First:
MI:
DOB:
Business Address:
City:
State:
Zip:
E-Mail:
*Social Security No.:
Phone:
Fax:
Corporate Name (if applicable):
EIN:
Please indicate which counties you practice
SECTION B.
CREDIT AND CRIMINAL HISTORY
Documents
Please check one
FBI
Clerk to send
On file with OPPG/obtained within last 5 years
Completed electronically
FDLE
Clerk to send
On file with OPPG/obtained within last 5 years
Completed electronically
Credit
Clerk to send
On file with OPPG/obtained within last 2 years
Attached
*Fingerprinting for “Professional Guardian” generates a combined FBI/FDLE (Level II) report.
SECTION C.
EDUCATION
C1. 40-Hour Professional Guardian Course
Certificate of Completion Attached
(please check one)
Name of Course and Date Completed:
Yes
On file
C2. Continuing Education Credits
16 OPPG approved continuing education credits are required every two-calendar years after completion of the 40-
hour course. Please refer to the chart examples below:
Year of 40-hour Professional Guardian Course completion
Two-year reporting periods
Course completed in 1999 or earlier
2006-2007 (due 2008) 2008-2009 (due 2010)
Course completed in 2000, 2002, 2004
2007-2008 (due 2009) 2009-2010 (due 2011)
Course completed in 2001, 2003, 2005
2006-2007 (due 2008)
2008-2009 (due 2010)
Course completed in 2006
2007-2008 (due 2009) 2009-2010 (due 2011)
Course completed in 2007
2008-2009 (due 2010) 2010-2011 (due 2012)
Course completed in 2008
2009-2010 (due 2011) 2011-2012 (due 2013)
Course completed in 2009
2010-2011 (due 2012)
2012-2013 (due 2014)
Course completed in 2010
2011-2012 (due 2013) 2013-2014 (due 2015)
Course completed in 2011
2012-2013 (due 2014) 2014-2015 (due 2016)
Course completed in 2012
2013-2014 (due 2015) 2015-2016 (due 2017)
Course completed in 2013
2014- 2015 (due 2016) 2016-2017 (due 2018)
Course completed in 2014
2015-2016 (due 2017) 2017-2018 (due 2019)
DOEA/OPPG Form 002, February 2017
Rule 58M-2.001, FAC
Page 1 of 2
OFFICE OF PUBLIC AND PROFESSIONAL GUARDIANS
Professional Guardian Employee Registration Form
This Professional Guardian Employee Form shall be included in the Professional Guardian file of:
SECTION A.
PROFESSIONAL GUARDIAN EMPLOYEE INFORMATION
Mr._ Ms._ Last Name:
First:
MI:
DOB:
Business Address:
City:
State:
Zip:
E-Mail:
*Social Security No.:
Phone:
Fax:
Corporate Name (if applicable):
EIN:
Please indicate which counties you practice
SECTION B.
CREDIT AND CRIMINAL HISTORY
Documents
Please check one
FBI
Clerk to send
On file with OPPG/obtained within last 5 years
Completed electronically
FDLE
Clerk to send
On file with OPPG/obtained within last 5 years
Completed electronically
Credit
Clerk to send
On file with OPPG/obtained within last 2 years
Attached
*Fingerprinting for “Professional Guardian” generates a combined FBI/FDLE (Level II) report.
SECTION C.
EDUCATION
C1. 40-Hour Professional Guardian Course
Certificate of Completion Attached
(please check one)
Name of Course and Date Completed:
Yes
On file
C2. Continuing Education Credits
16 OPPG approved continuing education credits are required every two-calendar years after completion of the 40-
hour course. Please refer to the chart examples below:
Year of 40-hour Professional Guardian Course completion
Two-year reporting periods
Course completed in 1999 or earlier
2006-2007 (due 2008) 2008-2009 (due 2010)
Course completed in 2000, 2002, 2004
2007-2008 (due 2009) 2009-2010 (due 2011)
Course completed in 2001, 2003, 2005
2006-2007 (due 2008)
2008-2009 (due 2010)
Course completed in 2006
2007-2008 (due 2009) 2009-2010 (due 2011)
Course completed in 2007
2008-2009 (due 2010) 2010-2011 (due 2012)
Course completed in 2008
2009-2010 (due 2011) 2011-2012 (due 2013)
Course completed in 2009
2010-2011 (due 2012)
2012-2013 (due 2014)
Course completed in 2010
2011-2012 (due 2013) 2013-2014 (due 2015)
Course completed in 2011
2012-2013 (due 2014) 2014-2015 (due 2016)
Course completed in 2012
2013-2014 (due 2015) 2015-2016 (due 2017)
Course completed in 2013
2014- 2015 (due 2016) 2016-2017 (due 2018)
Course completed in 2014
2015-2016 (due 2017) 2017-2018 (due 2019)
DOEA/OPPG Form 002, February 2017
Rule 58M-2.001, FAC
Page 1 of 2
C3. Continuing Education Courses
Date Completed
# of Credits
SECTION D.
EXAMINATION (Please check one)
Date of Examination:
Passed
OPPG waived my exam on
(date of waiver)
APPLICANT STATEMENT: I declare that my answers and all statements made by me herein are true and correct.
APPLICANT SIGNATURE:
DATE:
Please submit this form along with all fees to: Office of Public and Professional Guardians, Department of Elder
Affairs, 4040 Esplanade Way, Tallahassee, FL 32399-7000.
For Office Use Only
Reg. Period:
Registration #:
Check #:
Check Amount:
Credit Results Date:
FBI Results Date:
FDLE Results Date:
Exam/Waiver Date:
Status:
Status:
Status:
Status:
Reviewer Initials:
Reviewer
Initials:
Reviewer Initials:
Reviewer Initials:
Date Reviewed:
Date Reviewed:
Date Reviewed:
Date Reviewed:
Bond Expiration Date:
CEU Due Date:
Status:
Status:
Reviewer Initials:
Reviewer Initials:
Date Reviewed:
Date Reviewed:
Date Entered into CE Broker:
*The collection of social security numbers for record keeping is mandatory pursuant to Section 744.1083, F.S., and will not be available to
the general public.
This form must be submitted with your employer’s DOEA/OPPG Form 001 February 2017
DOEA/OPPG Form 002, February 2017
Rule 58M-2.001, FAC
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