IN THE CIRCUIT COURT OF THE EIGHTH JUDICIAL CIRCUIT, _________________ COUNTY, FLORIDA IN RE: GUARDIANSHIP/GUARDIAN ADVOCACY OF ________________________________, Ward CASE NO. ________________________ ____________________________________________________________________________ APPLICATION FOR APPOINTMENT AS STANDBY GUARDIAN ADVOCATE (FORM B) Pursuant to Florida Guardianship Law, the undersigned submits this Application for Appointment as Standby Guardian / Guardian Advocate of _____________________________________________, (the person with a developmental disability) and submits the following information (whenever the space provided is insufficient, attach additional pages): 1. 2. 3. 4. 5. 6. Name: ___________________________________________________________ Age: _____________________________________________ Residence Address: _________________________________________________ Mailing Address: ___________________________________________________ __________________________________________________________________ U.S. Citizen? Yes _______, No ________ Employer's Name and Address: _______________________________________ __________________________________________________________________ Applicant's Position: ________________________________________________ 7 8. Home Telephone Number: ___________________________________________ Work Telephone Number: ___________________________________________ If currently serving as guardian/guardian advocate for any other ward, list names of each ward, court file number(s), circuit court(s) in which case(s) is/are pending and whether applicant is acting as the limited or plenary guardian or guardian advocate of the person or property or both: American LegalNet, Inc. www.FormsWorkFlow.com __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 9. Does applicant have any physical disabilities? Yes _____ No _____ If yes, please describe and state whether such disability may affect applicant's ability, in any degree, to serve as guardian / guardian advocate: __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 10. Has applicant ever been treated for the following: a. b. c. d. Mental Condition Alcohol Drugs Other Yes ______ No ______ Yes ______ No ______ Yes ______ No ______ Yes ______ No ______ Nature of condition and summary of treatment: ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ 11. 12. Has applicant ever been judicially determined to have committed abuse or neglect against a child as defined by the Florida Statutes? Yes _______ No _______ Has applicant ever been the subject of a confirmed report of abuse, neglect, or exploitation which has been uncontested or upheld pursuant to the provisions of Sections 415.104 and 415.1075, Florida Statutes? Yes ______ No _______ 13. Has applicant ever been charged with fraud, misrepresentation or perjury in a judicial or administrative proceeding? Yes ______ No _______ If yes, please give date and complete details: __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com __________________________________________________________________ __________________________________________________________________ 14. Has applicant ever been charged with, arrested for or convicted of a felony? Yes _______ No ______ If yes, please furnish details including date, type of offense, location and final disposition: __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 15. Has applicant ever been charged with, arrested for or convicted of any other crimes? Yes _______ No _______ If yes, please furnish details including date, type of offense, location and final disposition: __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 16. Has applicant ever held a position which required bonding? Yes _____ No _____ If yes, please describe position, date, amount of bond and name of surety: __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 17. Has applicant, in the past, ever served as guardian/guardian advocate of a person or of a person's property? Yes ______ No ______ If yes, please describe below, including reason for termination of fiduciary position: __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com 18. Has applicant ever been held in contempt of court or removed as a guardian/guardian advocate? Yes ______ No ______ If yes, please describe below: __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 19. Has applicant ever filed for bankruptcy? Yes _____ No ______ If yes, please state date and location of court: __________________________________________________________________ __________________________________________________________________ 20. 21. What is applicant's relationship with the person with a developmental disability? _________________________________________________________________ Is applicant, or applicant