11 NCAC 08 .0604             APPLICATION FORM: CONTENTS

The application form requires the applicant to furnish all of the following pertinent information necessary to determine the qualifications of the applicant for a probationary certificate:

(1)           the date;

(2)           name, address and telephone number where applicant can be reached;

(3)           date of birth;

(4)           education;

(5)           work experience;

(6)           certificates and other professional licenses, if any, held previously or currently;

(7)           title of position to which appointed or promoted;

(8)           date of appointment or promotion to position;

(9)           governmental unit by which employed;

(10)         duties in a new position, in sufficient detail to determine appropriate type and level of certification;

(11)         name and title, certification, or other qualifications of persons to be responsible for supervision; and

(12)         Social Security number.

History Note:        Authority G.S. 143‑151.13;

Eff. June 28, 1979;

Amended Eff. July 18, 2002;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.