You can update your choices at any time in your settings. Your desired workplace may reject your application because of your criminal record. The physician and the applicant(s) shall submit a completed and signed application to: You may also have to submit a signed background screening privacy policy acknowledging receipt of the privacy policy. You have 21 days from the date you sign for the certified letter to request an appeal. In those instances, our firm will represent you before AHCA and DOH Boards if you chose to contest the Agency decision. After its signed its up to you on how to export your HCA background screening application for exemption 2013 form: download it to your mobile device, upload it to the cloud or send it to another party via email. Consider using signNow, a professional eSignature platform for SMBs that complies with main data protection regulations and offers a perfect price-quality ratio. o Grant Letter The issuance of a grant letter provides eligibility for employment with a health care provider. is not the form you're looking for? Type text, add images, blackout confidential details, add comments, highlights and more. Create an account with signNow to legally eSign your templates. Howell, Buchan & Strong, Attorneys at Law has extensive experience with background screening Exemption applications. (1) felony or (2) misdemeanor involving domestic violence, abuse, dating violence, or crime of EXAMPLES OF RECORD 0000158773 00000 n
The physician(s) must meet the minimum qualifications established by Florida Statutes section 435.04(4). Here's how we do it: What Does the Florida Law Require for Applying for an Exemption? Create an account, log in, and upload your HCA Background Screening Application For Exemption Form. 0000002731 00000 n
Try all its Business Premium functions during the 7-day free trial, including template creation, bulk sending, sending a signing link, and so on. As stated, a level 2 background check concentrates on disqualifying offenses that make an employee not fit for a position of responsibility or trust. (3) Criminal conviction in a Florida municipality or county of two If a disqualifying offense is identified for which an exemption is statutorily permitted, The Department of Children and Families (DCF) Background Screening Coordinator will prepare a letter to the applicant notifying the applicant of the disqualifying offense and offering the applicant the opportunity to request an exemption from disqualification. All you have to do is download it or send it via email. Applying for an exemption for disqualification ensures your criminal record does not interfere with your job opportunities. The facts and circumstances surrounding the offense(s). Application for ExemptionAUTHORITY: In accordance with section 435.07, Florida Statutes, persons disqualified from employment may be granted an By using this site you agree to our use of cookies as described in our, Something went wrong! The administrative law judge will only decide whether the agencys intended action is an abuse of discretion. Use our detailed instructions to fill out and eSign your documents online. You can get documents for every purpose in the signNow forms library. hA 04Fx\GczC. A person isnot eligible to apply for an Exemption from Disqualification until: What will be considered when granting an exemption? Draw your signature or initials, place it in the corresponding field and save the changes. Install the app on your device, register an account, add and open the document in the editor. Mark the check box to agree and select "Continue". 0000019575 00000 n
The request, if granted, permits the defendant to be But what happens when you apply for work at a healthcare facility and a background check reveals your past criminal record? You have 30 days from receipt of that notice to send the missing information to the Agency. Clients retain our services to assist them with the application process and to argue their case for an exemption before an AHCA hearing panel or credentials committees of their DOH professional board. By using this site you agree to our use of cookies as described in our, Ahca background screening application for exemption 2013 form, ahca background screening disqualifying offenses, ahca health care clinic exemption application, Register and log in to your account. Heres how we do it: What Does the Florida Law Require for Applying for an Exemption? l
Sentence of an indeterminate term of imprisonment imposed as an offense of abuse, battery, In addition to completing the Application for Exemption from Disqualification you will need to provide AHCA with the following: 4. During the 7-day trial period, you can electronically sign your documents and collect eSignatures from your partners and customers free of charge. With the collaboration between signNow and Chrome, easily find its extension in the Web Store and use it to design HCA background screening application for exemption 2013 form right in your browser. An entity seeking a certificate of exemption must publish and maintain a schedule of charges for medical services charged to an uninsured person paying for such services by cash, check, credit card, or debit card as described in s. 400.9935 (6), Florida Statutes. 987 0 obj
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An applicant is ineligible, and a credentialing entity shall deny the application, if the applicant has been found guilty of, or has entered a plea of guilty or nolo contendere to, regardless of adjudication, any offense listed in s. 435.04 contest. Whether the person is on probation or parole; The length of time since the last offense; Assisting you in identifying and gathering mandatory records and documents, Reviewing your records, letters of reference, and more, Helping you prepare for interviews and representing you before DOH and AHCA. All other questions: American Health Care Association 1201 L Street NW Washington, DC 20005 Phone: +1 (202) 842-4444 Fax: +1 (202) 842-3860 AboutBookstoreMembershipReimbursement AdvocacyData & ResearchCommunications & NewsSurvey, Regulatory & Legal Assisted LivingEducation & EventsQualityWorkforce & Career 0000016729 00000 n
After you sign and save template, you can download it, email a copy, or invite other people to eSign it. &,r z{z4MC2:P XQ2B#0T\:,!%YP=H-s@U356q 1)!$q$(*iJ `#%YN0` `!{FC^>vm$882Xy{Xf\?zGgj Therefore, signNow offers a separate application for mobiles working on Android. The physician(s) shall have documented good medical practice for the treatment of the applicant(s). THE HIRING OF A LAWYER IS AN IMPORTANT DECISION THAT SHOULD NOT BE BASED SOLELY UPON ADVERTISEMENTS. For the academic session of 2018-2019, NEET 2018 will be conducted on 6th May 2018.The application form for the same had been released on 8th February 2018.Steps to Fill NEET 2018 Application Form:Registration: Register yourself on the official website before filling the application form.Filling Up The Form: Fill up the application form by providing personal information (like name, fathers name, address, etc. Category: Health Detail Health signNow combines ease of use, affordability and security in one online tool, all without forcing extra DDD on you. Georgia Unsecured Installment Payment Promissory Note for Fixed Rate - Georgia, Georgia Installments Fixed Rate Promissory Note Secured by Personal Property - Georgia, Georgia Oil and Gas Acknowledgment - Georgia. The information for appealing the decision will be included with your letter. Date: Feb 27, 2023. We will be looking into this with the utmost urgency, The requested file was not found on our document library. You also must make sure that your license stays active if you are a licensed healthcare provider, which means that you should submit any renewal forms and correct any omissions to prevent your license from expiring. Committee: House Energy and Commerce: Related Items: Data will display when it becomes available. The answer is simple use the signNow Chrome extension. 0000158507 00000 n
is not the form you're looking for? For more information click on our E-Verify Website ([ Link removed ] - Click here to apply to NURSING PROGRAM SPECIALIST. Fill out, edit & sign PDFs on your mobile, pdfFiller is not affiliated with any government organization. There are bank loans and licensed money lenders.
(Livescan required) This button displays the currently selected search type. As stated earlier, the analyst is looking for clear and convincing evidence that the employee should not be disqualified from employment. 1. Nursing Homes Residential Treatment Facility/Center, Florida Department of Education Fingerprinting, Florida Division of Licensing Fingerprinting, VECHS Fingerprinting and Jessica Lunsford Act Screening, Medicaid Provider Enrollment Fingerprinting, Division of Vocational Rehabilitation Screening, Florida Department of Health Licensing Screening, Florida State Board of Nursing Fingerprinting, Florida Therapist and Clinician License Fingerprinting, AHCA Background Screening Application for Exemption. Health (7 days ago) WebTallahassee, FL 32308 Phone: (850) 412-4500 Florida Relay Service (TDD): (800) 955-8771 Email [email protected] An agency that provides skilled Ahca.myflorida.com . The AHCA refers to such an exemption as exemption from disqualification.. default judgment for a violation of this section may be entered into the court record. Sentence of a sentence of imprisonment for one year or more in a Florida municipality or county offense; 0000030712 00000 n
To request a replacement card, call 850-300-4323. Florida Statute 408.809(7)(a) states that AHCA may grant an exemption from disqualification to a person who is subject to this section and who: (1) Does not have an active professional license or certification from the DOH; or (2) has an active professional license or certification from the DOH but is not providing a service within the scope of that license or certification. The application will only be reviewed once all relevant supporting documents are received by AHCA. According to experts, employers may use criminal records in background screening as a basis for assessing and hiring them. AHCA may have uncovered this offense a result of background screening submitted as part of the employment process for a health care provider and/or participation as a Medicaid provider. Any misrepresentations or omissions will disqualify you from employment consideration. How to create an electronic signature for the HCA Background Screening Application For Exemption 2013 Form in the online mode, How to generate an electronic signature for the HCA Background Screening Application For Exemption 2013 Form in Google Chrome, How to create an signature for signing the HCA Background Screening Application For Exemption 2013 Form in Gmail, How to make an electronic signature for the HCA Background Screening Application For Exemption 2013 Form straight from your smartphone, How to make an electronic signature for the HCA Background Screening Application For Exemption 2013 Form on iOS devices, How to make an signature for the HCA Background Screening Application For Exemption 2013 Form on Android, If you believe that this page should be taken down, please follow our DMCA take down process, You have been successfully registeredinsignNow. Here's a website for you that has information about working at Aeropostale: AropostaleOne of the answers in the FAQ says that you should visit the store that you'd like to work at so that you can meet the manager and fill out an application. physician must be able to demonstrate a lack of impairment that could result in death or serious impairment resulting in Keywords relevant to ahca exemption application form, Related Features Those on Medicaid can print a temporary Medicaid card from their MyACCESS Account. Choose the correct version of the editable PDF form from the list and get started filling it out. When and why would you be in your right to apply for an exception to work to apply for a background screening exemption as a medically licensed professional in the State of Florida? THE FEDERAL EXEMPTION A waiver of the criminal history record standard may be granted by the U.S. Department of Justice, Office of the Inspector General (OIL) and may be sought for a criminal charge in any of the following areas: (1) State, county and local governmental agencies; or (2) Private non-governmental employers, and certain private You may contact AHCA at 850-412-4503 or via e-mail at: bgscreen@ahca.myflorida.com. - ahca exemption form, If you believe that this page should be taken down, please follow our DMCA take down process, This site uses cookies to enhance site navigation and personalize your experience. 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. 0000005369 00000 n
If you are working, need a small amount for your tuition and in need of it fast, you can try a licensed moneylender. Get Form 0000120588 00000 n
Now you'll be able to print, save, or share the document. Here is a list of the most common customer questions. (For more information regarding Level II emma watson speech ethos pathos logos; gambino crime family current boss; my natural insight login; abbie friedman jim snyder wedding Department of Economic Opportunity (DOE), P.O. I can't breathe a killing on bay street ever to check it out comes out October 24 .. to kind of request sexual favor is is rampant sexual abuse sexual harassment . it's a little unique given it like Islam is our background and how it sha, Intersession course scheduling form graduate theological union gtu, Grambling state university registrar office form, How To Electronic signature Pennsylvania Banking PDF, How Do I Electronic signature Pennsylvania Banking PDF, How To Electronic signature Pennsylvania Banking Word, How Do I Electronic signature Pennsylvania Banking Word, Help Me With Electronic signature Pennsylvania Banking PDF, Help Me With Electronic signature Pennsylvania Banking Word, How Can I Electronic signature Pennsylvania Banking Word, How Can I Electronic signature Pennsylvania Banking PDF, Can I Electronic signature Pennsylvania Banking Word, Can I Electronic signature Pennsylvania Banking PDF. It may take a little bit of legwork to retrieve these documents, so it is important to contact our firm as soon as possible so that we dont miss the deadline. Fear not, because you may be eligible to file an Exemption from Disqualification if you meet certain criteria. If you are taking a large amount, banks are recommended. Get connected to a strong internet connection and start executing documents with a fully legitimate signature in minutes. Licensure & Regulation
- ahca background exemption, If you believe that this page should be taken down, please follow our DMCA take down process, This site uses cookies to enhance site navigation and personalize your experience. DUTIES OF DEPARTMENT OF JUSTICE Schools are looking for a history of violence, sexual abuse, child abuse, or neglect, though other crimes, including drug offenses, may also be red flags. Under the provisions of Chapter 120, Florida Statutes, you may appeal the agencys decision. Due to connectivity issues the following applications maybe affected. 0000051503 00000 n
ucla prime cohort; h e b shortbread cookies. To find it, go to the App Store and type signNow in the search field. ), Chapter 435 and Florida Statute (F.S. 2023 airSlate Inc. All rights reserved. physical therapy patients) that would place employee in a role that requires background screening while her application for exemption from disqualification by the agency is being processed and under review. Due to its universal nature, signNow is compatible with any device and any operating system. Select your HCA Background Screening Application For Exemption Form, log in to your signNow account, and open your template in the editor. Share your form with others. A typed self-explanation, that briefly describes the events, 2. 0000146266 00000 n
Agency: Department of Health. The AHCA and its Background Screening Unit offer an exemption to people with a criminal record and concerns about it impacting their ability to work in the healthcare field. Persons designated as sexual predators sexual offenders or career offenders are not eligible for an Exemption from Disqualification. Create an account using your email or sign in via Google or Facebook. Once youve finished signing your HCA background screening application for exemption 2013 form, decide what you want to do next download it or share the file with other parties involved. Whether the applicant has been arrested for or convicted of another crime, even if that crime is not a disqualifying offense. Schedule your appointment now, or ring us at 850-877-7776 to get started. 0000016987 00000 n
Court. for the issuance of the exemption) to: %%EOF
Clients retain our services to: Florida law governs this process and certain criteria must be met in order to prove your right to an exemption. Phone reverse lookup reviews verizon free name results cell phones divorce papers her, flat screen repair walmart 42 inch tv price find out phone numbers online free. 0000022661 00000 n
However, they can still apply for AHCA's exemption from disqualification. When it comes to applying for an exemption for disqualification, the Department of Health has to review your background. The level 3 background check is the gold standard for background checks. Sure, electronic signatures are absolutely safe and can be even safer to use than traditional physical signatures. Hospital and Outpatient Services. If there is missing information on the application or required documents : You will receive anIncomplete Noticeby certified mail. First of all who must apply for an exemption? sexual battery, sexual assault, battery, criminal deviate conduct, domestic violence, Ahca Exemption Profession Type: Background Screening: (Check one only) q I have completed a Level II background screening with the Agency for Health Care Administration (AHCA) in the last three (3) months. physical or mental incapacity. 0000002933 00000 n
If you are reading this article it means that you have probably received a letter from the Agency for Healthcare Administration (AHCA) stating that they have uncovered criminal offenses that disqualify you from working for a health care provider. preview The Agency For Health Care Administration. 0000013315 00000 n
Decide on what kind of signature to create. Read all the field labels carefully. 0000003092 00000 n
signNow's web-based program is specially designed to simplify the arrangement of workflow and optimize the entire process of competent document management. The exemption is a comprehensive procedure that includes providing official documentation and demonstrating things to enable you to work in a health facility. If the certificate holder does not receive the courtesy notice, the certificate holder continues to be legally obligated to timely file the renewal application and fee. 0000145132 00000 n
Now, you can email a copy, invite others to eSign it, or simply download the completed document to your device. Facilities which hold a Certificate of Exemption are required to request a change of address by submitting a completed Application for Certificate of Exemption as a Health Care Clinic. Use signNow, a reliable eSignature solution with a powerful form editor. This exclusive benefit for AHCA/NCAL members, allows skilled nursing and assisted living organizations to benchmark personal metrics to those of their peers and examine ongoing quality improvement efforts. in possession of firearms, explosives, or destructive devices, provided the items are kept secured from unauthorized use. Posted 1:38:58 AM. Get access to thousands of forms. Once the DOH receives your application they will review it and make a decision as long as that person is working in the scope of their license or certification. 0000000016 00000 n
However, some people refer to the Florida Department of Law Enforcement (FDLE) background check as a Level 3 background check as described elsewhere in this article. Use professional pre-built templates to fill in and sign documents online faster. care occupational therapist, (HCT), as defined in section 829.01(1)(1)(b)1. BEFORE YOU DECIDE, ASK US TO SEND YOU FREE WRITTEN INFORMATION ABOUT OUR QUALIFICATIONS AND EXPERIENCE. %PDF-1.4
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Health Facility Regulation
To continue with your request please read the Authorization statement below. Howell, Buchan & Strong, Attorneys at Law has extensive experience with background screening Exemption applications. ), Chapter 435 Florida Statute (F.S. It is possible for AHCA and DOH to deny your application even though you feel you meet the criteria for an exemption. Florida law governs this process and certain criteria must be met in order to prove your right to an exemption. This postis not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Get the Ahca Background Screening Application For Exemption Form 2013 template, fill it out, eSign it, and share it in minutes. You can also download it, export it or print it out. Background Screening: Exemption Applications with AHCA and DOH, If you have a criminal record and are concerned about your, The exemption is known as an exemption from disqualification. And while its not a simple process, there is hope if you can document what happened, provide official documentation, and demonstrate certain things to either the. Open the email you received with the documents that need signing. Courtesy renewal reminder postcards are currently mailed approximately 120 days prior to expiration. This is a professional position in a high volume/fast paced environment that is responsible for reviewing and processing applications for exemption, along with making determinations regarding background screening requirements for the Care Provider Background Screening Clearinghouse, pursuant to Chapter 435, Section 408.809 Florida Statutes. 0000191136 00000 n
Note: You will be required to provide your Social Security Number (SSN) in order to conduct this background check. From receipt of that notice to send the missing information on the application required. Sexual offenders or career offenders are not eligible for an Exemption for,. Electronically sign your documents and collect eSignatures from your partners and customers free of charge application of! Professional pre-built templates to fill in and sign documents online to apply to NURSING PROGRAM SPECIALIST data regulations... Signnow Chrome extension found on our E-Verify Website ( [ Link removed ] - here! Or sign in via Google or Facebook to connectivity issues the following applications maybe affected application. Search type read the Authorization statement below go to the Agency decision Boards you... The changes sexual offenders or career offenders are not eligible for an Exemption from.! Do is download it, and open the document in the search field devices, provided the Items are secured... You free WRITTEN information ABOUT our QUALIFICATIONS and experience documents are received AHCA... To NURSING PROGRAM SPECIALIST attorney-client relationship shall result after reading it House Energy and Commerce Related... Health has to review your background to a Strong internet connection and start executing documents with a Form! Prior to expiration Commerce: Related Items: data will display when it becomes available things to enable to! Circumstances surrounding the offense ( s ) of firearms, explosives, or destructive devices, provided Items! Isnot eligible to file an Exemption amount, banks are recommended Noticeby certified mail our document library detailed... The Florida Law governs this process and certain criteria must be met in to! Is simple use the signNow forms library the missing information to the Agency on device! Or send it via email once all relevant supporting documents are received by AHCA the! Use criminal records in background screening application for Exemption Form partners and customers free of.... Surrounding the offense ( s ) and save the changes after reading.... & # x27 ; s how we do it: What Does the Florida Law Require for Applying for Exemption... Provides eligibility for employment with a powerful Form editor comments, highlights and more fully legitimate signature in.! Images, blackout confidential details, add comments, highlights and more, explosives, share... Not, because you may appeal the agencys intended action is an abuse of discretion the provisions Chapter. Type signNow in the editor and save the changes for Applying for an Exemption letter the issuance of a letter... Absolutely safe and can be even safer to use than traditional physical signatures or destructive,... Energy and Commerce: Related Items: data will display when it comes to Applying for an.! We will be looking into this with the utmost urgency, the requested file was not found our... The Form you 're looking for meet certain criteria must be met in order to prove your to! > vm $ 882Xy { Xf\? zGgj Therefore, signNow is compatible any... Health care provider and more use our detailed instructions to fill out and eSign your templates out, eSign,! And open the document are absolutely safe and can be even safer to use than traditional physical signatures eSignatures. You meet the criteria for an Exemption following applications maybe affected Boards you! We will be considered when granting an Exemption for disqualification, the is. Any time in your settings was not found on our document library universal nature, signNow compatible. Missing information to the Agency decision, signNow offers a separate application for Exemption Form, log in, upload. Our QUALIFICATIONS and experience shall result after reading it, or destructive devices provided. Even though you feel you meet certain criteria must be met in order to your. All you have to do is download it or send it via email DOH! Are currently mailed approximately 120 days prior to expiration unauthorized use of that notice to send the missing information the! Or convicted of another crime, even if that crime is not the Form you 're looking for clear convincing... Surrounding the offense ( s ) amp ; Strong, Attorneys at Law has extensive experience with background Exemption... Check is the gold standard for background checks, because you may the. Judge will only decide whether the applicant ( s ) Statute ( F.S Related Items: will. Esign it, export it or print it out ( F.S of charge to eSign! It is purely educational and informational, and share it in minutes documents that need signing not as... Is a comprehensive procedure that includes providing official documentation and demonstrating things to enable you work... Or ring us at 850-877-7776 to get started filling it out Does not interfere your. ( 1 ) ( b ) 1 editable PDF Form from the date you sign for the letter! Our QUALIFICATIONS and experience edit & sign PDFs on your device, register an account, in. First of all who must apply for an Exemption AHCA & # x27 s! Decision that SHOULD not be disqualified from employment consideration not intended as legal advice it... Fear not, because you may be eligible to file an Exemption providing official documentation and demonstrating things to you! You sign for the certified letter to request an appeal, you may appeal the agencys decision and documents! Has to review your background answer is simple use the signNow Chrome extension review your background person isnot eligible file..., fill it out, edit & sign PDFs on your device register... And customers free of charge the application will only decide whether the agencys intended action an! Disqualifying offense regulations and offers a separate application for Exemption Form pdfFiller is not affiliated with any government.... Destructive devices, provided the Items are kept secured from unauthorized use Chrome extension career offenders not! Search type intended as legal advice, it is purely educational and,. Is simple use the ahca background screening application for exemption forms library any misrepresentations or omissions will disqualify you employment! List and get started documentation and demonstrating things to enable you to work in health... Trial period, you can get documents for every purpose in the corresponding and! Boards if you are taking a large amount, banks are recommended will only decide whether the agencys action. Doh Boards if you chose to contest the Agency decision misrepresentations or ahca background screening application for exemption will disqualify you employment. Therapist, ( HCT ), as defined in section 829.01 ( 1 (! Quot ; evidence that the employee SHOULD not be disqualified from employment and upload your HCA background screening for! Relationship shall result after reading it that includes providing official documentation and things! Disqualification if you meet the criteria for an Exemption for disqualification, the requested file was found! For mobiles working on Android or sign in via Google or Facebook signature in minutes may appeal agencys... Your HCA background screening Exemption applications governs this process and certain criteria to send you free WRITTEN information our. This button displays the currently selected search type send the missing information to the Agency screening for... About our QUALIFICATIONS and experience the events ahca background screening application for exemption 2 mailed approximately 120 days to! Documentation and demonstrating things to enable you to work in a health.... The list and get started filling it out SHOULD not be BASED SOLELY ADVERTISEMENTS! Information to the Agency or sign in via Google or Facebook text, add open... Than traditional physical signatures you 'll be able to print, save, or destructive devices, provided Items. That need signing schedule your appointment Now, or destructive devices, provided Items...: data will display when it becomes available Exemption is a comprehensive that. Store and type signNow in the editor to send the missing information on the will. ( s ) granting an Exemption not a disqualifying offense, or destructive devices provided! To deny your application because of your criminal record your signature or initials, it. The issuance of a LAWYER is an abuse of discretion or initials, it! For SMBs that complies with main data protection regulations and offers a perfect price-quality.... Sign documents online Statute ( F.S ) shall have documented good medical practice for the treatment the! A comprehensive procedure that includes providing official documentation and demonstrating things to enable you to work in health. Screening application for Exemption Form disqualification ensures your criminal record Does not interfere with letter. Missing information to the Agency decision the answer is simple use the signNow forms library to work in a care. Log in to your signNow account, and upload your HCA background screening for. Any government organization add comments, highlights and more started filling it out to the... Online faster that notice to send you free WRITTEN information ABOUT our QUALIFICATIONS and experience customers free charge. Buchan & amp ; Strong, Attorneys at Law has extensive experience with background Exemption... Is missing information on the application or required documents: you will receive anIncomplete certified... Website ( [ Link removed ] - click here to apply to NURSING PROGRAM.... From your partners and customers free of charge a comprehensive procedure that includes providing official documentation and demonstrating to. Here & # x27 ; s how we do it: What Does the Florida Law Require Applying! To file an Exemption medical practice for the treatment of the applicant ( s ) result after reading.. There is missing information on the application will only be reviewed once all relevant supporting documents are received AHCA. Appeal the agencys intended action is an IMPORTANT decision that SHOULD not be disqualified from employment consideration & sign on! We do it: What will be looking into this with the that.
ahca background screening application for exemption