Form CJSTC68 "Affidavit of Applicant" - Florida

What Is Form CJSTC68?

This is a legal form that was released by the Florida Department of Law Enforcement - 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 10, 2017;
  • The latest edition provided by the Florida Department of Law Enforcement;
  • 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 Form CJSTC68 by clicking the link below or browse more documents and templates provided by the Florida Department of Law Enforcement.

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Download Form CJSTC68 "Affidavit of Applicant" - Florida

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CJSTC
AFFIDAVIT OF APPLICANT
68
Florida Department of
Incorporated by Reference in Rule 11B-27.002(1)(f), F.A.C.
Law Enforcement
Please type or print in black or blue ink and use capital and small letters for names, titles, and addresses
Last Four Digits of Applicant’s Social Security Number:
Applicant’s Legal Name:
Last
First
MI
Employing agency:
Use this form to verify your compliance with the employment requirements of Section 943.13, F.S. I fully understand that to qualify for employment as a law enforcement, correctional, or
correctional probation officer, I shall comply with the following provisions of Section 943.13, F.S.:
shall not be eligible for employment or appointment as an officer, notwithstanding suspension
Be at least 19 years of age.
of a sentence or withholding of adjudication.
Be a citizen of the United States.
Have been fingerprinted by the employing agency.
Be a high school graduate or equivalent.
Have passed a physical examination by a licensed medical specialist approved in Rule
Not have been convicted of any felony or of a misdemeanor involving perjury or false
11B-27.002(1)(d), F.A.C..
statement. Any person who, after July 1, 1981, pleads guilty or nolo contendere to or is
Be of good moral character.
found guilty of a felony or of a misdemeanor involving perjury or a false statement
Have not received a dishonorable discharge from the U.S. Military.
True
False NA
In addition, I attest to the following statements: Each statement shall be checked “True” “False” or “NA”
1. I completed my employment application and it is true and correct, and all other information
I furnished in conjunction with my application is true and correct.
2. I provided documentation of proof of my qualifications to the above listed employing agency.
3. I meet the qualifications as specified above.
4. I had a criminal record sealed or expunged.
5. I am under investigation by a local, state, or federal agency or entity for criminal, civil, or administrative wrongdoing to the best of my knowledge and belief.
6. I separated or resigned from a previous criminal justice employment while under investigation.
7. I am currently serving in good standing in the U.S. Military.
8. I previously served in the U.S. Military.
9. I received a dishonorable discharge from my previous U.S. Military service.
10. I am currently certified as a Florida criminal justice officer in the following area(s): Please check the appropriate box(es).
Law Enforcement
Correctional
Correctional Probation
11. I authorize the employing agency listed above to apply for my certification. Please check the appropriate box(es).
Law Enforcement
Correctional
Correctional Probation
NOTICE: This document shall constitute as an official statement within the purview of Section 837.06, F.S., and is subject to verification by the employing agency and the Criminal Justice
Standards and Training Commission. Any intentional omission when submitting this application or false execution of this affidavit shall constitute a misdemeanor of the second degree and
disqualify the officer for employment as an officer.
PLEASE READ CAREFULLY BEFORE SIGNING. You must complete the remainder of this affidavit in the presence of a notary public. Upon witnessing your signing of this affidavit, a notary public
shall complete the notary block by entering the same date the affidavit is signed. I hereby certify that to the best of my knowledge and belief, the information that I’ve entered on this form is
true.
12.
13.
Applicant’s Signature
Date Signed
14. OATH
Pursuant to Section 117.05(13)(a), Florida Statutes
STATE OF
COUNTY OF
Sworn to (or affirmed) and subscribed before me this
day of
, year
, By
Signature of Notary Public – State of Florida
Print, Type, or Stamp Commissioned name of Notary Public
Personally Known
OR Produced Identification
Type of Identification Produced
*NOTE: Private Correctional facilities must submit original and shall forward the completed affidavit stapled to the Registration of Employment, Affidavit of Compliance
Form CJSTC-60 to FDLE, Criminal Justice Professionalism Program, Post Office Box 1489, Tallahassee, Florida 32302-1489, Attention Records Section
Created 1/1/1992
Original - Agency
Copy – FDLE
1 of 1
Commission-Approved Revisions: 8/10/17
Form Effective Date: 8/2018
CJSTC
AFFIDAVIT OF APPLICANT
68
Florida Department of
Incorporated by Reference in Rule 11B-27.002(1)(f), F.A.C.
Law Enforcement
Please type or print in black or blue ink and use capital and small letters for names, titles, and addresses
Last Four Digits of Applicant’s Social Security Number:
Applicant’s Legal Name:
Last
First
MI
Employing agency:
Use this form to verify your compliance with the employment requirements of Section 943.13, F.S. I fully understand that to qualify for employment as a law enforcement, correctional, or
correctional probation officer, I shall comply with the following provisions of Section 943.13, F.S.:
shall not be eligible for employment or appointment as an officer, notwithstanding suspension
Be at least 19 years of age.
of a sentence or withholding of adjudication.
Be a citizen of the United States.
Have been fingerprinted by the employing agency.
Be a high school graduate or equivalent.
Have passed a physical examination by a licensed medical specialist approved in Rule
Not have been convicted of any felony or of a misdemeanor involving perjury or false
11B-27.002(1)(d), F.A.C..
statement. Any person who, after July 1, 1981, pleads guilty or nolo contendere to or is
Be of good moral character.
found guilty of a felony or of a misdemeanor involving perjury or a false statement
Have not received a dishonorable discharge from the U.S. Military.
True
False NA
In addition, I attest to the following statements: Each statement shall be checked “True” “False” or “NA”
1. I completed my employment application and it is true and correct, and all other information
I furnished in conjunction with my application is true and correct.
2. I provided documentation of proof of my qualifications to the above listed employing agency.
3. I meet the qualifications as specified above.
4. I had a criminal record sealed or expunged.
5. I am under investigation by a local, state, or federal agency or entity for criminal, civil, or administrative wrongdoing to the best of my knowledge and belief.
6. I separated or resigned from a previous criminal justice employment while under investigation.
7. I am currently serving in good standing in the U.S. Military.
8. I previously served in the U.S. Military.
9. I received a dishonorable discharge from my previous U.S. Military service.
10. I am currently certified as a Florida criminal justice officer in the following area(s): Please check the appropriate box(es).
Law Enforcement
Correctional
Correctional Probation
11. I authorize the employing agency listed above to apply for my certification. Please check the appropriate box(es).
Law Enforcement
Correctional
Correctional Probation
NOTICE: This document shall constitute as an official statement within the purview of Section 837.06, F.S., and is subject to verification by the employing agency and the Criminal Justice
Standards and Training Commission. Any intentional omission when submitting this application or false execution of this affidavit shall constitute a misdemeanor of the second degree and
disqualify the officer for employment as an officer.
PLEASE READ CAREFULLY BEFORE SIGNING. You must complete the remainder of this affidavit in the presence of a notary public. Upon witnessing your signing of this affidavit, a notary public
shall complete the notary block by entering the same date the affidavit is signed. I hereby certify that to the best of my knowledge and belief, the information that I’ve entered on this form is
true.
12.
13.
Applicant’s Signature
Date Signed
14. OATH
Pursuant to Section 117.05(13)(a), Florida Statutes
STATE OF
COUNTY OF
Sworn to (or affirmed) and subscribed before me this
day of
, year
, By
Signature of Notary Public – State of Florida
Print, Type, or Stamp Commissioned name of Notary Public
Personally Known
OR Produced Identification
Type of Identification Produced
*NOTE: Private Correctional facilities must submit original and shall forward the completed affidavit stapled to the Registration of Employment, Affidavit of Compliance
Form CJSTC-60 to FDLE, Criminal Justice Professionalism Program, Post Office Box 1489, Tallahassee, Florida 32302-1489, Attention Records Section
Created 1/1/1992
Original - Agency
Copy – FDLE
1 of 1
Commission-Approved Revisions: 8/10/17
Form Effective Date: 8/2018