Form Cc-008 - Certificate Of Competency Application Page 5
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26CERTIFICATE OF COMPETENCY APPLICATION
Section 4 -Background Questions
Yes No
4.1.Have you ever been convicted, found guilty of, or entered a plea of nolo contendere
to, regardless of adjudication a crime in any jurisdiction? This question applies to
any criminal violation of the laws of any municipality; which includes county, state,
or federal without regard to whether you were placed on probation, had adjudication
withheld, were paroled, or pardoned. Traffic offenses and civil citations which
include parking, speeding, inspections and traffic signals are exempt.
If you intend to answer “no” because you believe your records are expunged or sealed
by court order pursuant to section 943.0585 or 943.059 of Florida Statute or the
applicable law of another state, proof of expungement may need to be provided if the
expunged records appear on a background check. Your answer to this question will
be checked against local, state, and federal records. Failure to answer this question
accurately may result in the denial of your application.
Yes No
4.2.Have you ever had any construction related trade certificate of competency license
denied, or is there now pending a proceeding or investigation to deny such an
application from any construction related certificate of competency licensee
authority (Federal, State, County or municipal) within the United States?
Yes No
4.3.Has any license, registration, or permit to practice any regulated profession,
occupation, vocation, or business been revoked, annulled, suspended, relinquished,
surrendered, or otherwise disciplined in Florida or in any other jurisdiction, or is any
such proceeding or investigation now pending?
Yes No
4.4.Have you been charged with acting as a contractor without a license, (issued Notice
of Non-Compliance, Notice of Violation or a Citation), convicted of same, and
received any disciplinary action (including a fine(s) such as a citation or reprimand)
by any State, County or Municipality.
Section 5 - Explanation Section
If you answered yes to any of the questions in Section IV, please complete Section V, explain in detail in the section
provided, and include any supporting legal documents. If necessary, include explanation on a separate sheet.
Background Summary
Offense:
County:
State:
Penalty/ Disposition:
Date of Offense:
Have all sanctions been satisfied?
(mm/dd/yyyy)
Yes
No
Description:
Page 4 of 8
Form CC-008
Certificate of Competency Application
Rev. 12/9/16
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