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How to apply for AHCA’s Exemption from Disqualification?

First of all who must apply for an exemption?


Any individual employed or seeking employment with a health care provider licensed by the Agency for Health Care Administration that has been notified by the employer that they have been found guilty of, regardless of adjudication, or entered a plea of guilty or nolo contendre to any of the criminal offenses listed in sections 435.03(2) , 435.04(2), and 408.809 Florida Statutes.


The health care providers that may require you to have an exemption in order to work are:



Adult Day Care Center Health Care Services Pool
Adult Family Care Home Home Health Agency
Assisted Living Facility Home Medical Equipment
Community Mental Health Homemaker/Companion Service
Crisis Stabilization Unit Hospice
Health Care Clinic ICF/DD

Nurse Registry                                                  Prescribed Pediatric Extended Care

Nursing Homes                                                 Residential Treatment Facility/Center


NOTE: Even if you have received an exemption from disqualification from another state agency, you are still required to apply for an exemption through this Agency. Proof of exemption must be provided with the application. The Agency will take into consideration any exemption that is granted through another state agency when making a decision


Who is eligible for an exemption?


A person is not eligible to apply for an Exemption from Disqualification until:


  • He/she has been lawfully released from confinement, probation or other sanction for a disqualifying misdemeanor criminal offense;
  • At least 3 years after he/she has been lawfully released from confinement, probation or other sanction for a disqualifying felony criminal offense.Persons designated as sexual predators, sexual offenders or career offenders are not eligible for an Exemption from Disqualification.You must demonstrate by clear and convincing evidence that you will not present a danger if employed within the healthcare field. Types of information that must be submitted with your application include:
    • A completed Level 2 screening (If the screening was conducted through the Agency a copy will be on file. If you need to request a screening, please follow instruction found in this document under How to Request a Level 2 Screening)
    • Arrest reports for all arrests
    • Court dispositions for all arrests
    • A letter from parole or probation regarding your current status
    • 3-5 letters of reference (at least one must be from a current or recent employer on the employer’s letterhead)
    • Any information regarding counseling, education, technical training, employment history, community involvement, awards or special recognition


What will be considered when granting an exemption?

  • the circumstances surrounding the criminal incident for which an exemption is sought;
  • the time period that has elapsed since the incident;
  • the nature of the harm caused to the victim;
  • a history of the employee since the incident; and
  • any other evidence or circumstances indicating that the individual is leading a positive lifestyle.


How to apply for an exemption.


An “Application for Exemption”, AHCA Form #3110-0019, must be completed and returned along with ALL required documents noted on the Checklist that is included with the application.

For your convenience you may download the exemption application from the following link:


Download: AHCA Background Screening Application for Exemption


When you submit the application, be sure to include all the required documents or a statement as to why a document is not included with the application. AN INCOMPLETE APPLICATION WILL RESULT IN A DELAY IN THE PROCESSING AND FINAL DECISION OF THE CASE.


How long does the process take?

An Application for Exemption will not be reviewed until ALL the required documents are received by the Agency.

If there is missing information on the application or required documents :


You will receive an Incomplete Notice by certified mail. You have 30 days from receipt of that notice to send the missing information to the Agency. If it will take longer than 30 days, contact the analyst reviewing your case (name is on the incomplete notice) to request an extension. If all the information is not received within 30 days, your case will be CLOSED and you will have to send in a new application.

Once the application and all documentation are complete you will receive one of the following:

  • Hearing Notice – a personal interview will be scheduled with the hearing committee in order to make a determination. The initial hearing is generally held by telephone and is an informal process in which the committee will ask specific questions regarding your criminal/abuse history, work history, and reasons for wanting to work within the healthcare field.


Upon completion of the hearing, a recommendation is made by the committee to either grant or deny the application. The Agency’s Secretary or his delegate makes the final decision. The applicant is then notified by mail regarding the decision.


  • Grant Letter – The issuance of a grant letter provides eligibility for employment with a health care provider. The granting of an exemption by any State Department (including this Agency) does not change the results of a background screening or clear your criminal history. The exemption only provides eligibility for employment despite the presence of a disqualifying offense(s). The applicant must provide a copy of the grant letter to each potential health care employer.


If you receive a judgment for a disqualifying criminal offense after the date exemption is granted, the exemption will be voided and your employer (if a health care provider) will be notified that you are no longer eligible to work.


  • Denial Letter – is issued when the head of the Agency has determined that the safety of the patients/residents of a health care provider may be at risk. Under the provisions of Chapter 120, Florida Statutes, you may appeal the agency’s decision. The information for appealing the decision will be included with your letter. You have 21 days from receipt of the denial letter to request an appeal.


Where to send the application:

  • The Agency reviews applications and makes decisions for Exemptions for unlicensed personnel working for a health care provider.

If you are seeking employment in a health care provider as a:

  • facility owner, administrator or chief financial officer;
  • staff person that is uncertified or unlicensed


    Send your application to:

    Background Screening Unit 


    Agency for Healthcare Administration
    2727 Mahan Drive MS #40
    Tallahassee, FL 32308
    (850) 412-4503



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