Form IG/BSU-006 "Annual Affidavit of Compliance With Level 2 Screening Standards" - Florida

What Is Form IG/BSU-006?

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 May 1, 2019;
  • 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;
  • Fill out the form in our online filing application.

Download a fillable version of Form IG/BSU-006 by clicking the link below or browse more documents and templates provided by the Florida Department of Juvenile Justice.

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Download Form IG/BSU-006 "Annual Affidavit of Compliance With Level 2 Screening Standards" - Florida

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IG/BSU-006
Revised 05/2019
DEPARTMENT OF JUVENILE JUSTICE
OFFICE OF THE INSPECTOR GENERAL
BACKGROUND SCREENING UNIT
Annual Affidavit of Compliance with Level 2 Screening Standards
STATE OF FLORIDA
COUNTY OF
I,
, with the
,
(Facility Representative)
(Facility/Program)
a Department of Juvenile Justice or contracted provider employer, hereby affirm, under penalty of perjury, that each
employee and volunteer has complied with the Level 2 background screening requirements as stated in Chapters 984
and 985 and Section 435.04, Florida Statutes, as well as the Department’s background screening policy, procedures,
and rules.
I also affirm the following was completed before the individuals were allowed to have contact with youth or
confidential youth records:
All employees and volunteers in positions of special trust or responsibility were fingerprinted, the
Department’s Background Screening Unit received the fingerprint results, and an eligible determination was
made.
A staff with hiring authority:
Reviewed each applicant’s Criminal History Report, considered the number and type of offense, and the
o
time since the last offense.
o
Reviewed the following reports and modules: Central Communication Center(CCC)-Person Involvement
Report, Florida Department of Law Enforcement (FDLE) Automated Training Management System
(ATMS) Report, the Staff Verification System (SVS) Module, if applicable, and completed any required
reviews of personnel records from previous employers. (Volunteers are exempt from the SVS module
check.)
o
Administered your agency’s assessment tool to each new hire and placed the tool and pass rate, score, or
measure in the personnel file.
___________________________________________________
SIGNATURE OF AFFIANT
Sworn to and subscribed before me this _______ day of ________________________, 20_________.
__________________________________________________
SIGNATURE OF NOTARY PUBLIC, STATE OF FLORIDA
(Print, Type, or Stamp Commissioned Name of Notary Public)
Affiant personally known to notary
or
Affiant produced Identification
(Check One)
Type of Identification Produced:
Clear Form
Save As..
Print
IG/BSU-006
Revised 05/2019
DEPARTMENT OF JUVENILE JUSTICE
OFFICE OF THE INSPECTOR GENERAL
BACKGROUND SCREENING UNIT
Annual Affidavit of Compliance with Level 2 Screening Standards
STATE OF FLORIDA
COUNTY OF
I,
, with the
,
(Facility Representative)
(Facility/Program)
a Department of Juvenile Justice or contracted provider employer, hereby affirm, under penalty of perjury, that each
employee and volunteer has complied with the Level 2 background screening requirements as stated in Chapters 984
and 985 and Section 435.04, Florida Statutes, as well as the Department’s background screening policy, procedures,
and rules.
I also affirm the following was completed before the individuals were allowed to have contact with youth or
confidential youth records:
All employees and volunteers in positions of special trust or responsibility were fingerprinted, the
Department’s Background Screening Unit received the fingerprint results, and an eligible determination was
made.
A staff with hiring authority:
Reviewed each applicant’s Criminal History Report, considered the number and type of offense, and the
o
time since the last offense.
o
Reviewed the following reports and modules: Central Communication Center(CCC)-Person Involvement
Report, Florida Department of Law Enforcement (FDLE) Automated Training Management System
(ATMS) Report, the Staff Verification System (SVS) Module, if applicable, and completed any required
reviews of personnel records from previous employers. (Volunteers are exempt from the SVS module
check.)
o
Administered your agency’s assessment tool to each new hire and placed the tool and pass rate, score, or
measure in the personnel file.
___________________________________________________
SIGNATURE OF AFFIANT
Sworn to and subscribed before me this _______ day of ________________________, 20_________.
__________________________________________________
SIGNATURE OF NOTARY PUBLIC, STATE OF FLORIDA
(Print, Type, or Stamp Commissioned Name of Notary Public)
Affiant personally known to notary
or
Affiant produced Identification
(Check One)
Type of Identification Produced:
Clear Form
Save As..
Print