Get Form 235

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 employees or has volunteers in service who meet the definition of a direct service provider. See 435. 02 430. 0402 Fla* Stat. A direct service provider is a person 18 years of age or older who pursuant to a program to provide services to the elderly has direct face to face contact with a client while providing services to the client and has access to the client s living area funds personal property or personal identification information as defined in s. 817. 568. The term includes coordinators managers and supervisors of residential facilities and volunteers. 430. 0402 1 b Fla* Stat. ATTESTATION As the duly authorized representative of Employer Name located at Street Address City State ZIP code I do hereby affirm under penalty of perjury Name of Representative that the above named employer is in compliance with the provisions of Chapter 435 and section 430. 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 employees or has volunteers in service who meet the definition of a direct service provider. 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 employees or has volunteers in service who meet the definition of a direct service provider. See 435. 02 430. 0402 Fla* Stat. A direct service provider is a person 18 years of age or older who pursuant to a program to provide services to the elderly has direct face to face contact with a client while providing services to the client and has access to the client s living area funds personal property or personal identification information as defined in s.