Form Cc-008 - Certificate Of Competency Application Page 12
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26STEP BY STEP APPLICATION INSTRUCTIONS
1.4.Application Review Fee: please include a fee of $225.00 with application submittal.
Payment must be made to the BOCC –Board of County Commissioners. Application
Review fee of $225.00 is Non Refundable and submitted with application. The balance
of $225.00 is payable when application is deemed complete and ready to be put on Board
agenda. You will be contacted by phone or email requesting the balance due.
Required:
$225.00 Check or Money Order
Section 2 – Applicant Personal Information
2.1.Photograph: please attach a 2 x 2 passport size photo.-required
2.2.Full Legal Name: Please make sure to include your middle name or initial if you have
one. Name must match all other official identification and documents submitted.
2.3.Citizenship Status: Social Security number, driver’s license information, citizenship
and place of birth.
Required Documentation:
Proof of Citizenship: Resident Alien Card, or Working Visa Documents, etc.
Social Security Card and
A clear copy of valid driver’s license or other government issued photo identification.
NOTICE OF COLLECTION OF SOCIAL SECURITY NUMBERS FOR GOVERNMENT PURPOSES:
UNDER THE FEDERAL PRIVACY ACT, DISCLOSURE OF SOCIAL SECURITY NUMBERS IS
VOLUNTARY UNLESS SPECIFICALLY REQUIRED BY FEDERAL STATUTE. IN THIS INSTANCE,
SOCIAL SECURITY NUMBERS ARE MANDATORY PURSUANT TO TITLE 42 UNITED STATES CODE,
SECTIONS 653 AND 654: AND SECTIONS 409.2677 AND 409.2598, FLORIDA STATUES, TO ALLOW
EFFICIENT SCREENING OF APPLICANTS AND LICENSES BY A TITLE IV-D CHILD SUPPORT
AGENCY TO ASSURE COMPLIANCE WITH CHILD SUPPORT OBLIGATIONS. SOCIAL SECURITY
NUMBERS MUST ALSO BE RECORDED ON ALL PROFESSIONAL AND OCCUPATIONAL LICENSE
APPLICATIONS AND WILL BE USED FOR LICENSEE IDENTIFICATION PURSUANT TO THE
PERSONAL RESPONSIBILITY AND WORK OPPORTUNITY RECONCILIATION ACT OF 1996
(WELFARE REFORM ACT).
2.4.Residential Address: Please list the full permanent physical address of your residence
and not of your business, if different. Do not list a Postal Office (PO) address. All official
communication including license renewals are sent to the home address and not your
business address, if different.
Section 3 – Business Information
3.1.Company Information: complete company’s legal name as filed with the Secretary of
State including d/b/a (fictitious name) if applicable. Name of business owner needs to be
completed especially if other than applicant.
Form CC-08-01
Page 2 of 5
Instructions
Rev. 12/9/16
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