SECTION II MILITARY HISTORY
a. Are you an honorably discharged United States veteran, as dened in Section 1.01, Florida
Statutes?
b. Have you ever been ned, disciplined, or court-martialed under the Uniform Code of Military
Justice or other service regulation?
If YES, provide a complete and accurate account of this matter on a separate sheet of paper
and provide copies of all ofcial military documents related to the incidents.
YES NO
SECTION III CRIMINAL HISTORY
a. Are you currently on parole or probation or in a deferred prosecution program, a pre-trial
intervention program, or another similar program; or are you currently serving another form
of state or federal supervision?
If YES, provide a certied copy of the court disposition for the relevant cases.
b. Have you ever been convicted of, or had adjudication withheld on, a misdemeanor or
YES NO
YES NO
felony? (Do not include non-criminal trafc violations.)
If YES, in the space provided below, provide complete and accurate information regarding
each arrest AND provide a certied copy of the court disposition for each case.
ARREST DATE CHARGE(S)
COUNTY
STATE DISPOSITION
ARREST DATE CHARGE(S)
COUNTY
STATE DISPOSITION
Use additional sheet of paper if necessary. Falsication of information provided or failure to provide
certied copies of court dispositions may result in the denial of your application.
SECTION IV ALIAS INFORMATION
Have you ever been known by a name other than the name on page one of this application?
(Includes maiden names, married names, ctitious names, legal name changes, etc.)
If YES, in the space provided below, provide complete and accurate information regarding
each name. Use additional sheet of paper if necessary.
NAME NAME
NAME NAME
YES NO
SECTION V PERSONAL HISTORY
a. Have you ever been adjudicated incapacitated under Chapter 744, F.S., or similar law of
another state?
If YES, include with your application a certied copy of the court document restoring
capacity.
b. Have you ever been involuntarily placed in a treatment facility for the mentally ill under
Chapter 394, F.S., or similar law of another state?
If YES, include with your application a certied copy of the court document restoring
competency.
YES NO
YES NO
FDACS-16007 Rev. 01/17
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YES NO