DJJ Form IG/BSU-007 "Request for Exemption" - Florida

What Is DJJ Form IG/BSU-007?

This is a legal form that was released by the Florida Department of Juvenile Justice - 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 August 1, 2018;
  • The latest edition provided by the Florida Department of Juvenile Justice;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of DJJ Form IG/BSU-007 by clicking the link below or browse more documents and templates provided by the Florida Department of Juvenile Justice.

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Download DJJ Form IG/BSU-007 "Request for Exemption" - Florida

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IG/BSU-007 PART 2
Created 08/18
FLORIDA DEPARTMENT OF JUVENILE JUSTICE
REQUEST FOR EXEMPTION
If you can apply for an exemption, you must complete and return this Request for Exemption form,
the attached application and must provide all documentation required on the Description of Arrest
and Rehabilitation form.
Pursuant to Section 435.07(3), Florida Statutes, you must demonstrate by clear and convincing
evidence that you should receive an exemption and not be disqualified from seeking certain
employment opportunities. If you choose to seek an exemption, you have the burden of providing
sufficient evidence of rehabilitation. We will review and consider the time period that has passed
since the criminal incident, the nature of harm caused to the victim, and any other evidence or
circumstances indicating that you will not present a danger working directly with juveniles.
Prior to continuing with this application, you must verify you understand the following
information by checking the box next to each statement, signing and dating this form:
I have been determined to be not eligible for employment/volunteer.
1.
2.
Three years or more have passed since I have been released from prison, probation,
parole or other criminal-related supervision that had been court ordered for a
disqualifying felony criminal offense.
 I am not under any type of probation, Pre-Trial Intervention or criminal-related
3.
supervision that has been court-ordered due to a disqualifying misdemeanor
criminal offense.
4.
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.
5.
I am not designated as a sexual predator, sexual offender, or career offender.
6.
I am formally requesting that the Department, in accordance with the provisions of
Chapter 435 and 985, Florida Statutes, provide me with an Exemption Review.
7.
I understand that I must provide clear and convincing evidence to support a reasonable
belief that I am rehabilitated and that I pose no danger to the health or safety of juveniles.
I understand I must submit this form with the required supporting documents within
8.
45 calendar days from the date I received notice that I was no eligible.
9.
I understand that the decision of the Department of Juvenile Justice regarding this
Exemption may be contested through a hearing under the provisions of Chapter 120,
F.S.
10.
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.
______________________________________
_________________________________
Print Name
Signature
/
/
Date
IG/BSU-007 PART 2
Created 08/18
FLORIDA DEPARTMENT OF JUVENILE JUSTICE
REQUEST FOR EXEMPTION
If you can apply for an exemption, you must complete and return this Request for Exemption form,
the attached application and must provide all documentation required on the Description of Arrest
and Rehabilitation form.
Pursuant to Section 435.07(3), Florida Statutes, you must demonstrate by clear and convincing
evidence that you should receive an exemption and not be disqualified from seeking certain
employment opportunities. If you choose to seek an exemption, you have the burden of providing
sufficient evidence of rehabilitation. We will review and consider the time period that has passed
since the criminal incident, the nature of harm caused to the victim, and any other evidence or
circumstances indicating that you will not present a danger working directly with juveniles.
Prior to continuing with this application, you must verify you understand the following
information by checking the box next to each statement, signing and dating this form:
I have been determined to be not eligible for employment/volunteer.
1.
2.
Three years or more have passed since I have been released from prison, probation,
parole or other criminal-related supervision that had been court ordered for a
disqualifying felony criminal offense.
 I am not under any type of probation, Pre-Trial Intervention or criminal-related
3.
supervision that has been court-ordered due to a disqualifying misdemeanor
criminal offense.
4.
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.
5.
I am not designated as a sexual predator, sexual offender, or career offender.
6.
I am formally requesting that the Department, in accordance with the provisions of
Chapter 435 and 985, Florida Statutes, provide me with an Exemption Review.
7.
I understand that I must provide clear and convincing evidence to support a reasonable
belief that I am rehabilitated and that I pose no danger to the health or safety of juveniles.
I understand I must submit this form with the required supporting documents within
8.
45 calendar days from the date I received notice that I was no eligible.
9.
I understand that the decision of the Department of Juvenile Justice regarding this
Exemption may be contested through a hearing under the provisions of Chapter 120,
F.S.
10.
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.
______________________________________
_________________________________
Print Name
Signature
/
/
Date
IG/BSU-007a
Created 08/18
APPLICATION FOR EXEMPTION
Applicant Information: Please type or print legibly. All questions must be answered:
Last Name:
First Name:
Middle Name:
Mailing Address:
Phone number: Please include area
code
City:
State: FL
Zip:
Email:
SSN:
Date of Birth: mm/dd/yyyy
Sex:

Male

Female
List all prior names, aliases, AKAs:
Race:
White
Black
Indian
Asian or Pacific
Other: __________________
2737 Centerview Drive, Tallahassee, Florida 32399-3100
Phone#: 850.921.6345
Fax#: 850.921.6348 or 850.717.2678
IG/BSU-007b
Created 08/18
DESCRIPTION OF ARREST & REHABILITATION
Write, sign and notarize a statement written by you that includes questions 1 & 2:
1. Explain, in detail, the following related to all arrests; your disqualifying
offenses and offenses that are not disqualifying:
• The circumstances of your offense(s)
• If there was a victim, include the victim’s age and relationship to you and the
sentence you received.
• If your offense was related to theft, include the item(s) and the approximate
value of the item(s) stolen.
• Explain how your actions affected the lives of others and how it impacted your
life.
2. Explain the time that has elapsed since the disqualifying offense.
• Your personal history since the offense (include work, education, civic, religious
history, etc.)
• If you worked for DJJ or our contracted provider in the past
• Why you want to work with the Department of Juvenile Justice or our contracted
provider
• Include what you believe you have to offer the agency or juveniles
• Include other information that indicates you will not present a danger to the safety or
well-being of juveniles.
3. Also Attach:
• Documentation of Rehabilitation-Rehabilitation may consist of successful
completion of a court-ordered treatment or counseling program, educational or
training certificates, proof of participation in community activities, special recognition
or awards.
• 3-5 Letters of Recommendation-Letters must be from individuals you have known
for at least two years through contact at the workplace, community activities,
education or training centers. Letters should not be more than six months old and
individuals providing a letter should include their name, address and telephone
number for verification or possible interview.
• A resume
• Exemption letters you received from other State agencies
2737 Centerview Drive, Tallahassee, Florida 32399-3100
Phone#: 850.921.6345
Fax#: 850.921.6348 or 850.717.2678
IG/BSU-007c
Created 08/18
COMMUNITY SUPERVISOR RECORDS REQUEST
(Submit this form If you need a copy of your probation or parole termination letter)
Date:
To:
Florida Department of Corrections
Office of Community Corrections
501 S Calhoun Street, Room 141
Tallahassee, FL 32399
E-mail: OBIStech-clemency@fdc.myflorida.com
From:
Date of Birth:
Race:
Sex:
FDC#:
Phone:
E-mail: _____________________
County/Counties of Supervision and case number for disqualifying case/s:
1.
3.
2.
4.
RE: Department of Juvenile Justice Background Screen Exemption
I am applying to the Florida Department of Juvenile Justice (DJJ) for an exemption in
reference to my recent Background Screening. The application requests information
about my past community supervision. Can you provide the following information?
1. The period of supervision:
Start Date: ___________
Termination Date: ___________
_______Early Termination
Normal Termination_______
2. If there were any violations during the period of supervision was it a:
________ New Arrest
______Technical
Both _______
3. Were all conditions completed? __________________________
Thank you in Advance,
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2737 Centerview Drive, Tallahassee, Florida 32399-3100
Phone#: 850.921.6345
Fax#: 850.921.6348 or 850.717.2678
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