5265 Placida Road, Grove City, FL 34224
Thank you for offering your time and talent to work with our parish. Volunteers such as yourself are indispensable to our programs.
DIOCESE OF VENICE - ATTESTATION OF GOOD MORAL CHARACTER
Saint Francis of Assisi Church, Grove City, FL
I attest, under penalty of perjury, that I am of good moral character. I further attest that I have not committed, nor been found guilty of, regardless of adjudication, or entered a plea of nolo contendere or guilty to any offense prohibited under any of the following provisions of the Florida Statutes (see Level 2 Screening Standard of 435.04) or under any similar statute of another jurisdiction:
a. Section 415.111, relating to adult abuse, neglect, or exploitation of aged persons or disabled adults.
b. Section 782.04, relating to murder.
c. Section 782.07, relating to manslaughter, aggravated manslaughter of an elderly person or disable adult, or aggravated manslaughter of a child.
d. Section 782.071, relating to vehicular homicide.
e. Section 782.09, relating to killing of an unborn child by injury to the mother.
f. Section 784.011, relating to assault, if the victim of the offense was a minor.
g. Section 784.021, relating to aggravated assault.
h. Section 784.03, relating to battery, if the victim of the offense was a minor.
i. Section 784.045, relating to aggravated battery.
j. Section 787.01, relating to kidnaping.
k. Section 787.02, relating to false imprisonment.
l. Section 787.04 (2) and (3) relating to taking, enticing or removing a child beyond the state limits with criminal intent pending custody proceedings or to avoid producing a child at a custody hearing.
m. Section 790.115(1) or (2.b), relating to exhibiting firearms or weapons within 1,000 feet of a school or possessing an electric weapon or device, destructive device or other weapon on school property.
n. Section 794.011, relating to sexual battery.
o. Former s. 794.041, relating to prohibited acts of persons in familial or custodial authority.
p. Chapter 796, relating to prostitution.
q. Section 798.02, relating to lewd and lascivious behavior.
r. Chapter 800, relating co lewdness and indecent exposure.
s. Section 806.01, relating to arson.
t. Chapters 810 and 812, relating to burglary, theft, robbery, and related crimes, if the offense was a felony.
u. Section 817.563, relating to fraudulent sale of controlled substances, only if the offense was a felony.
v. Section 825.102, relating to abuse, aggravated abuse, or neglect of an elderly person or disabled adult.
w. Section 825.1025, relating to lewd offenses committed upon or in the presence of an elderly person or disabled adult
x. Section 825.103, relating to exploitation of an elderly person or disabled adult, if the offense was a felony.
y. Section 826.04, relating to incest.
z. Section 827.03, relating to child abuse, aggravated child abuse, or neglect of a child.
aa. Section 827.04, relating to contributing to the delinquency or dependency of a child.
bb. Section 827.05, relating to negligent treatment of children.
cc. Section 827.071, relating to sexual performance by a child.
dd. Section 843.01, relating to resisting arrest with violence.
ee. Section 843.025, depriving a law enforcement, correctional, or probation officer means of protection/communication.
ff. Section 843.12 or 843.13 relating to aiding in an escape or in the escape of juvenile inmates.
gg. Chapter 847, relating to obscene literature.
hh. Section 874.05(1) relating to encouraging or recruiting another to join criminal gang.
ii. Chapter 893, relating to drug abuse prevention and control, only if the offense was a felony.
jj. Those offenses under Chapters 944 and 985 identified in Florida Statute 435.04 as disqualifying.
kk. Have not committed an act that constitutes domestic violence as defined in section 741.30.
ll. Do not have confirmed report of abuse, neglect of exploitation defined in section 39.01 upheld under section 415.103.
I understand that any volunteer work is conditioned upon a satisfactory criminal background and reference check and that offenses other than those listed above may preclude my volunteer work to the extent they reflect on my fitness for the position. I authorize, without reservation, the release of information to the Diocese of Venice and do further release, agree to hold harmless and discharge from all damages and liability, Frank J. Dewane, as Bishop of the Diocese of Venice, a corporation sole, the Diocese and all companies, agencies, officials, officers, employees and other persons, who in good faith provide to the Diocese of Venice information in order to successfully complete a background investigation. I further agree to inform the Diocese of Venice immediately if I am charged with or arrested for any disqualifying offenses while engaged in employment, volunteer work, or other work on behalf of the Diocese.
By submission of this form, I certify that the information contained in this application is true and complete to the best of my knowledge.
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