1. (a) An individual who wishes to file a petition for a predetermination of whether the individual's criminal history will likely disqualify the individual from obtaining a license from the Board shall submit a petition in writing at the office of the Board.

2. (b) The petition shall include the petitioner's:

   1. (1) legal name;
   2. (2) mailing, physical, and email addresses;
   3. (3) social security number;
   4. (4) date of birth;
   5. (5) telephone number;
   6. (6) criminal record report prepared no more than 60 days prior to the date of petition by the agency designated by the Board;
   7. (7) written statement describing the circumstances surrounding the commission of the crime(s);
   8. (8) written statement of any rehabilitation efforts;
   9. (9) rehabilitative drug or alcohol treatments;
   10. (10) Certificate of Relief granted pursuant to G.S. 15A-173.2;
   11. (11) affidavits or other written documents, including character references, that the petitioner intends to submit for review;
   12. (12) certification that the this information provided is true and complete;
   13. (13) signature.
3. (c) The fee for a petition for predetermination shall be forty-five dollars ($45.00).

History Note: Authority G.S. 87-18; 93B-8.1(b6);
Eff. July 1, 2020.