SECTION V PERSONAL HISTORY
c. Have you ever been diagnosed with a mental illness?
d Do you currently abuse any controlled substance?
e. Do you have a history of controlled substance abuse?
abuse rehabilitation program and three letters of reference, one of which should be from
f. Do you have a history of alcohol abuse?
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YES NO
YES NO
YES NO
YES NO
a.
b. Have you previously been licensed to perform security duties in Florida or another state?
licensed:
STATE:______________ PERIOD OF LICENSURE:________________________
STATE:______________ PERIOD OF LICENSURE:________________________
c.
proceeding in Florida or another state?
If YES, provide on a separate sheet of paper complete details regarding this action,
d. Are you requesting credit for relevant military training or education that is substantially
similar to that required for this license as provided in Rule 5N-1.119, Florida Administrative
Code?
YES NO
YES NO
YES NO
SECTION VII CERTIFICATION OF QUALIFIED EXEMPTION FROM PUBLIC RECORD DISCLOSURE
record disclosure. Leave blank if not applicable.
YES NO
YES NO
SECTION VIII CITIZENSHIP
a. Are you a citizen of the United States?
must
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?
YES NO
YES NO