SECTION V PERSONAL HISTORY
c. Have you ever been diagnosed with a mental illness?
If YES, include with your application a statement from a psychiatrist or psychologist licensed
in Florida attesting that you are not currently suffering from an incapacitating mental illness
that precludes you from performing regulated duties of an unarmed security ofcer.
d Do you currently abuse any controlled substance?
If YES, you are ineligible for licensure.
e. Do you have a history of controlled substance abuse?
If YES, include with your application evidence of successful completion of a substance
abuse rehabilitation program and three letters of reference, one of which should be from
your sponsor in the rehabilitation program.
f. Do you have a history of alcohol abuse?
If YES, include with your application evidence of successful completion of an alcohol abuse
rehabilitation program and three letters of reference, one of which should be from your
sponsor in the rehabilitation program.
FDACS-16007 Rev. 01/17
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YES NO
YES NO
YES NO
YES NO
SECTION VI TRAINING/EXPERIENCE
a. Have you successfully completed the training required for licensure as a Security Ofcer
pursuant to Section 493.6303(4), F. S.?
If YES, include with your application a copy of your certicate of completion.
If NO, your application for licensure may be denied.
b. Have you previously been licensed to perform security duties in Florida or another state?
If YES, please specify which states and the periods of time during which you were
licensed:
STATE:______________ PERIOD OF LICENSURE:________________________
STATE:______________ PERIOD OF LICENSURE:________________________
c. Have you ever had a security ofcer license or registration revoked, suspended, or otherwise
acted against (including probation, ne, reprimand, or surrender of license) in a disciplinary
proceeding in Florida or another state?
If YES, provide on a separate sheet of paper complete details regarding this action,
including the state in which the action occurred, relevant dates, and circumstances.
d. Are you requesting credit for relevant military training or education that is substantially
similar to that required for this license?
If YES, include your DD with your application.
YES NO
YES NO
YES NO
SECTION VII CERTIFICATION OF QUALIFIED EXEMPTION FROM PUBLIC RECORD DISCLOSURE
I have read the instructions for Section VII. I hereby certify that I qualify for exemption under
Chapter 119, Florida Statutes, and want to keep the specied information exempt from public
record disclosure. Leave blank if not applicable.
YES NO
YES NO
SECTION VIII CITIZENSHIP
a. Are you a citizen of the United States?
If YES, proceed to Section I.
If NO, you must answer uestion b below.
b. Are you deemed a lawful permanent resident alien by the United States Citizenship and
Immigration Services (USCIS) or have you been authorized to work in the U.S. by the
USCIS?
If YES, proceed to Section I.
If you are not a lawful permanent resident alien or do not possess valid wor authorization,
you are not eligible for licensure.
YES NO
YES NO