0402 Florida Statutes regarding level 2 background screening. Signature of Representative Date STATE OF FLORIDA COUNTY OF Sworn to or affirmed and subscribed before me this day of 20 by to me or produced as proof of identification. Print Type or Stamp Commissioned Name of Notary Public Notary Public DOEA Form 235 Affidavit of Compliance Employer Effective April 2012 Form available at http //elderaffairs. BACKGROUND SCREENING Affidavit of Compliance - Employer AUTHORITY This form is required annually of all employers to comply with the attestation requirements set forth in section 435. 05 3 Florida Statutes. The term employer means any person or entity required by law to conduct background screening including but not limited to Area Agencies on Aging Aging Resource Centers Aging and Disability Resource Centers Lead Agencies Long Term Care Ombudsman Program Serving Health Insurance Needs of Elders Program Service Providers Diversion Providers and any other person or entity which hires em....
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How to fill out the Form 235 online
Filling out the Form 235 is an essential step for employers to comply with Florida's background screening requirements. This guide will provide you with clear, step-by-step instructions to help you successfully complete the form online.
Follow the steps to fill out the Form 235 online:
- Press the ‘Get Form’ button to obtain the document and open it in your chosen text editor.
- Enter the employer name in the designated section. Ensure the name matches the legal name of your organization.
- Complete the street address, including city, state, and ZIP code where the employer is located.
- Fill in the name of the authorized representative who will affirm compliance. This person should be a designated individual within your organization.
- The authorized representative must sign the form in the designated signature line, ensuring the name is written clearly.
- Insert the date when the form is signed.
- Complete the notary section by specifying the county and date of the notarization. The notary public will complete the rest of this section once they verify the identity of the signatory.
- Once the form is fully completed, save your changes and download the document if necessary. You can then print or share it as required.
Start filling out your Form 235 online today to meet your compliance obligations.
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