12 NCAC 09I .0107           PROFESSIONAL CERTIFICATES FORMS

The following Commission-approved forms shall be used by individuals to apply for a new or replacement Professional Certificate:

(1)           Form F-6 (LE), Application for Award of Law Enforcement Certificate, shall include the following:

(a)           Applicant's name, date of birth, and last four digits of Social Security Number;

(b)           Applicant's address, phone number, and email address;

(c)           Applicant's employing agency and agency address;

(d)           Type of award applying for;

(e)           Law enforcement experience (agencies and years of law enforcement experience);

(f)            Completed law enforcement training courses;

(g)           Level of college education;

(h)           Name and signature of applicant; and

(i)            Name and signature of agency head or In-Service Training Coordinator.

(2)           Form F-6 (DAC), Application for Award of Criminal Justice Certificate, shall include the following:

(a)           Applicant's name, date of birth, and last four digits of Social Security Number;

(b)           Applicant's address, phone number, and email address;

(c)           Applicant's employing agency and agency address;

(d)           Type of award applying for;

(e)           Criminal justice experience (agencies and years of criminal justice experience);

(f)            Completed criminal justice training courses;

(g)           Level of college education;

(h)           Name and signature of applicant; and

(i)            Name and signature of agency head or In-Service Training Coordinator.

(3)           Form F-6 (DJJ), Application for Award of Juvenile Justice Certificate, shall include the following:

(a)           Applicant's name, date of birth, and last four digits of Social Security Number;

(b)           Applicant's address, phone number, and email address;

(c)           Applicant's employing agency and agency address;

(d)           Type of award applying for;

(e)           Juvenile justice experience (agencies and years of juvenile justice experience);

(f)            Completed juvenile justice training courses;

(g)           Level of college education;

(h)           Name and signature of applicant; and

(i)            Name and signature of agency head or In-Service Training Coordinator.

(4)           Form F-7, Request for Replacement of Professional Certificate, shall include the following:

(a)           Awardee's name, date of birth, and last four digits of Social Security Number;

(b)           Awardee's address, phone number, and email address;

(c)           Type of replacement certificate;

(d)           Printed name and signature of awardee; and

(e)           Name and signature of agency head or In-Service Training Coordinator, if still employed at an agency.

History Note:        Authority G.S. 17C-6;

Eff. February 1, 2026.