"Public Records Disclosure Exemption Questionnaire Form" - Florida

Public Records Disclosure Exemption Questionnaire Form is a legal document that was released by the Florida Department of Juvenile Justice - a government authority operating within Florida.

Form Details:

  • Released on April 1, 2018;
  • The latest edition currently provided by the Florida Department of Juvenile Justice;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Florida Department of Juvenile Justice.

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DEPARTMENT OF JUVENILE JUSTICE
PUBLIC RECORDS DISCLOSURE EXEMPTION QUESTIONNAIRE
This questionnaire is intended to ensure Department compliance with Florida’s Public Records laws. Please read and
provide an answer of “YES” or “NO” to each of the questions listed below.
Employee Name: ________________________________________________________
Program Area/Unit _______________________________________________________
(Print)
Employee PF ID: ______________
Yes
No
Question
1
Are you currently or have you ever been a law enforcement employee, including a correctional officer
or a correctional probation officer?
Are you the spouse or child of the above?
2
Are you currently or have you ever been an employee of the Department of Children and Family
Services whose duties include the investigation of abuse, neglect, exploitation, fraud, theft, or other
criminal activities?
Are you the spouse or child of the above?
3
Are you currently or have you ever been an employee of the Department of Health whose duties are
to support the investigation of child abuse or neglect?
Are you the spouse or child of the above?
4
Are you currently or have you ever been an employee of the Department of Revenue or local
governments whose responsibilities include revenue collection and enforcement or child support
enforcement?
Are you the spouse or child of the above?
5
Are you a firefighter certified in compliance with FL Statutes 633.35?
Are you the spouse or child of the above?
6
Are you a justice of the Supreme Court, district court of appeal judge, circuit court judge, or county court
judge?
Are you the spouse or child of the above?
7
Are you currently or have you ever been a state attorney, assistant state attorney, statewide
prosecutor, or assistant statewide prosecutor?
Are you the spouse or child of the above?
8
Are you currently or have you ever been a human resource, labor relations, or employee relations
director, assistant director, manager, or assistant manager of any local government agency or water
management district whose duties include hiring and firing employees, labor contract negotiation,
administration, or other personnel-related duties?
Are you the spouse or child of the above?
9
Are you currently or have you ever been a United States attorney or assistant United States attorney?
Are you the spouse or child of the above?
10
Are you currently or have you ever been a judge of United States Courts of Appeal, United States
district judge, or United States magistrate judge?
Are you the spouse or child of the above?
11
Are you currently or have you ever been a code enforcement officer?
Are you the spouse or child of the above?
12
Are you currently or have you ever been a guardian-ad-litem, as defined in FL Statutes 39.820?
Are you the spouse or child of the above?
13
Are you currently or have you ever been a juvenile probation officer, juvenile probation supervisor,
detention superintendent, assistant detention superintendent, senior juvenile detention officer, juvenile
detention officer supervisor, juvenile detention officer, house parent I or II, house parent supervisor,
group treatment leader, group treatment leader supervisor, rehabilitation therapist, or social services
counselor of the Department of Juvenile Justice?
Are you the spouse or child of the above?
Are you currently or have you ever been employed in an agency’s office of inspector general or internal
14
audit department whose duties include auditing or investigating waste, fraud, abuse, theft, exploitation,
or other activities that could lead to criminal prosecution or administrative discipline?
Are you the spouse or child of the above?
HRES Revised 4/2018
DEPARTMENT OF JUVENILE JUSTICE
PUBLIC RECORDS DISCLOSURE EXEMPTION QUESTIONNAIRE
This questionnaire is intended to ensure Department compliance with Florida’s Public Records laws. Please read and
provide an answer of “YES” or “NO” to each of the questions listed below.
Employee Name: ________________________________________________________
Program Area/Unit _______________________________________________________
(Print)
Employee PF ID: ______________
Yes
No
Question
1
Are you currently or have you ever been a law enforcement employee, including a correctional officer
or a correctional probation officer?
Are you the spouse or child of the above?
2
Are you currently or have you ever been an employee of the Department of Children and Family
Services whose duties include the investigation of abuse, neglect, exploitation, fraud, theft, or other
criminal activities?
Are you the spouse or child of the above?
3
Are you currently or have you ever been an employee of the Department of Health whose duties are
to support the investigation of child abuse or neglect?
Are you the spouse or child of the above?
4
Are you currently or have you ever been an employee of the Department of Revenue or local
governments whose responsibilities include revenue collection and enforcement or child support
enforcement?
Are you the spouse or child of the above?
5
Are you a firefighter certified in compliance with FL Statutes 633.35?
Are you the spouse or child of the above?
6
Are you a justice of the Supreme Court, district court of appeal judge, circuit court judge, or county court
judge?
Are you the spouse or child of the above?
7
Are you currently or have you ever been a state attorney, assistant state attorney, statewide
prosecutor, or assistant statewide prosecutor?
Are you the spouse or child of the above?
8
Are you currently or have you ever been a human resource, labor relations, or employee relations
director, assistant director, manager, or assistant manager of any local government agency or water
management district whose duties include hiring and firing employees, labor contract negotiation,
administration, or other personnel-related duties?
Are you the spouse or child of the above?
9
Are you currently or have you ever been a United States attorney or assistant United States attorney?
Are you the spouse or child of the above?
10
Are you currently or have you ever been a judge of United States Courts of Appeal, United States
district judge, or United States magistrate judge?
Are you the spouse or child of the above?
11
Are you currently or have you ever been a code enforcement officer?
Are you the spouse or child of the above?
12
Are you currently or have you ever been a guardian-ad-litem, as defined in FL Statutes 39.820?
Are you the spouse or child of the above?
13
Are you currently or have you ever been a juvenile probation officer, juvenile probation supervisor,
detention superintendent, assistant detention superintendent, senior juvenile detention officer, juvenile
detention officer supervisor, juvenile detention officer, house parent I or II, house parent supervisor,
group treatment leader, group treatment leader supervisor, rehabilitation therapist, or social services
counselor of the Department of Juvenile Justice?
Are you the spouse or child of the above?
Are you currently or have you ever been employed in an agency’s office of inspector general or internal
14
audit department whose duties include auditing or investigating waste, fraud, abuse, theft, exploitation,
or other activities that could lead to criminal prosecution or administrative discipline?
Are you the spouse or child of the above?
HRES Revised 4/2018
DEPARTMENT OF JUVENILE JUSTICE
PUBLIC RECORDS DISCLOSURE EXEMPTION QUESTIONNAIRE
If you answered “NO” to ALL of the questions, please sign and date below.
_______________________________________
__________________________
Signature
Date
If you answered “YES” to any one of the questions, please read and sign and date below.
I have read and truthfully answered to the best of my knowledge all the questions listed above. I understand that
by virtue of my affirmative response(s) above, I am entitled to have certain personal information about me and/or
my spouse and children that may be in the Department’s possession withheld from public disclosure in the event
of a public records request pursuant to Chapter 119, Florida Statutes.
_________________________________________
________________________
Signature
Date
MANAGERS AND SUPERVISORS SHOULD FORWARD COMPLETED FORMS TO THE BUREAU OF HUMAN
RESOURCES.
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