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

1. (1) the date;
2. (2) name, address, and telephone number where applicant can be reached;
3. (3) date of birth;
4. (4) education;
5. (5) work experience;
6. (6) certificates and other professional licenses, if any, held previously or currently;
7. (7) type and level of certificate for which application is made;
8. (8) governmental unit by which currently employed;
9. (9) supporting data needed for verification of applicant's qualifications called for by Rule .0706 or .0707 of this Section; and
10. (10) Social Security number.

History Note: Authority G.S. 143‑151.13;
Eff. January 15, 1980;
Amended Eff. July 18, 2002;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. January 9, 2018.