Get Florda Criminal Self Reporting Document Form

Filling out the Florida Criminal Self Reporting Document Form online is essential for licensees who have been convicted of a crime. This guide provides a clear, step-by-step approach to help you accurately complete the form, ensuring you meet the necessary reporting requirements.

Follow the steps to successfully complete the form online.

1. Click ‘Get Form’ button to obtain the form and access it in the editor.
2. Enter your last name (surname), first name, and middle name in the designated fields.
3. Provide your date of birth in the specified format.
4. Fill in your home address, including the street address, city, state, and zip code.
5. List your home telephone number and cell number in the respective fields.
6. Input your email address to facilitate communication.
7. Detail your profession(s) by listing all DBPR licenses you hold.
8. Record your professional license number(s) associated with your DBPR licenses.
9. In sections 12 and 13, indicate whether you have pled guilty or no contest to any crime or been convicted of any crime in any jurisdiction by checking 'Yes' or 'No.'
10. For each crime you have disclosed, provide the required information, including the name and address of the court, case number, date of plea or conviction, and the name of the crime.
11. If you have more than three convictions to report, you must attach an additional sheet containing the same information for each additional conviction.
12. Ensure you date the form and include your signature as the licensee.
13. After completing the form, you have options to save changes, download, print, or share the form as needed.

Complete your Florida Criminal Self Reporting Document Form online today to ensure compliance with reporting requirements.