Fill - Free fillable Mcppo Recertification Application Form (Commonwealth of Massachusetts) PDF form

Massachusetts Certified Public Purchasing Official Program

Massachusetts Office of the Inspector General

One Ashburton Place, Room 1311

Boston, MA 02108

Phone: 617-727-9140

Fax: 617-723-2334

Email: MA-IGO-Training@state.ma.us

Application for Designation of Massachusetts Certified Public Purchasing Officer (MCPPO)

After satisfying the class and training requirements for one of the MCPPO designations, an individual may

apply for designation in the appropriate category. The application requires information about the

applicant’s current position, classes and trainings completed, relevant work history, education, and any

criminal or civil violations. To be eligible for any designation, the applicant must currently hold a public

procurement position with a Massachusetts public entity.

Education and Experience Requirements

Designation

Education

Experience

MCPPO

High school diploma or equivalent, and successful

completion of the Public Contracting Overview, Supplies

and

Services Contracting, and Design and Construction

Contracting classes*

Bachelor’s degree and successful completion of the 3

designated classes

Bachelor’s degree, qualifying graduate degree in a related

field, and successful completion of the 3 designated

classes

5 years public procurement, ** including 2 years

management or supervisory experience in MA***

4 years public procurement, ** including 2 years

management or supervisory experience in MA***

3 years public procurement, ** including 2 years

management or supervisory experience in MA***

MCPPO for

Supplies and

Services

High school diploma or equivalent and successful

completion of the Public Contracting Overview and

Supplies and Services Contracting classes.

[same

criteria as above for education substitutes]

[same criteria as above]

MCPPO for

Design and

Construction

High school diploma or equivalent and successful

completion of the Public Contracting Overview and

Design and Construction Contracting classes. [same

criteria as above for education substitutes]

[same criteria as above]

Associate

Levels

(available for

all designations)

High school diploma or equivalent and successful

completion of required classes as outlined above.

1 year public procurement in MA

Required MCPPO classes must be completed within three years prior to application.

** “Procurement” means buying, purchasing, leasing, or otherwise acquiring supplies, services, design services, or construction work, and all of the functions that

pertain to such acquisition, including description of requirements, selection of sources, solicitation and evaluation of offers, contract preparation and award, and all

phases of contract administration, performed by an individual employed by a public entity. To qualify as public procurement experience,

a position must entail a

minimum of 75 hours per month.

*** “Management” means managing or administering a procurement activity, but does not include principally clerical or data entry functions. To be considered a

public procurement management position, a position must entail:

decision-making authority with respect to procurement activities, or

authority with respect to the procurement activities of public employees whose primary responsibility is procurement, or

substantial responsibility for providing legal advice on procurement matters to public employees whose primary responsibility is

procurement, or

substantial responsibility for conducting performance reviews or audits of public procurement activities.

“Supervisory” means supervising (with authority to hire and fire) public employees whose primary responsibility is procurement.

Massachusetts Certified Public Purchasing Official Program

Massachusetts Office of the Inspector General

One Ashburton Place, Room 1311 Boston, MA 02108

Phone: 617-727-9140

Fax: 617-723-2334

Email: MA-IGO-Training@state.ma.us

Application for Designation of Massachusetts Certified Public Purchasing Official (MCPPO)

General Information

Mr. Mrs. Ms. Dr.

Name to appear on certificate: ________ __

Last First Middle initial

Job title:

Jurisdiction/agency: Telephone no._ ______

Business address:_ City:__________________ State:___ Zip code: _______

Home address: City: State:_ _ Zip code: _______

Phone: D.O.B.: E-mail address:

Designation Requested

□ MCPPO □ Associate MCPPO

□ MCPPO for Supplies and Services □ Associate MCPPO for Supplies and Services

□ MCPPO for Design and Construction □ Associate MCPPO for Design and Construction

□ MCPPO Recertification

Dates and titles of MCPPO

classes attended: ______

Work Experience

List the most recent position and all employment relevant to the designation requirements. Applications for other than an

Associate designation require a separate position description signed by your supervisor that indicates your management or

supervisory experience and responsibilities.

Starting/Ending Dates Employer Jurisdiction/Agency Official Position

Academic Degrees Earned

All applicants must provide information on high school or equivalent. Provide college and graduate school information if

requesting a substitution for work experience.

Name and Location Major Graduation Year Degree

1. High school or equivalent

2. College

3. Graduate school

4. Other

- Continued –

Application Fee:

$75 (non-refundable if designation is denied)

Mail to:

Office of the Inspector General

MCPPO Program

One Ashburton Place, Room 1311

Boston, MA 02108

Release

I hereby swear under the pains and penalties of perjury that the information in this application is complete and accurate.

I hereby authorize the Office of the Inspector General to obtain records from all educational institutions and places of

employment listed in this application for the purpose of verifying my level of education, employment history and faithful

adherence to the law.

Signature of applicant Date

Application Fee

NOTE: Faxed and emailed applications will not be accepted. Payment must accompany your application. Allow 90 days for

processing.

Reminder: Recertification is required every 3 years from the award date of an MCPPO designation certificate.

1

CORI Acknowledgement Form

The Office of the Inspector GeneralisregisteredundertheprovisionsofM.G.L.c. 6,§172toreceiveCriminal Offender

Record Information (CORI)forthe purpose ofscreeningcurrentandprospectiveemployees, contractors,interns, co-ops,

volunteers, license applicants or current licensees.

For prospective or current employees, contractors, interns, co-ops and volunteers, the Office of the Inspector General

will request all CORI information, including out-of-state CORI information; for license applicants and current licensees,

the Office of the Inspector General will only request information available under standard access as provided by 803

CMR 2.05(4)(a).

Asaprospectiveorcurrentemployee,contractor,intern, co-op, volunteer,licenseapplicant or currentlicensee,I

understandthata CORIcheckwillbesubmittedformypersonalinformationtotheDepartment of Criminal Justice

Information Services (DCJIS).Iherebyacknowledgeandprovidepermissiontothe Office of the Inspector Generalto

submit a CORI check for my information to the DCJIS. This authorization is valid for one year from the date

of mysignature.Imaywithdrawthisauthorizationatanytimebyprovidingthe Office of the Inspector General with

written notice of my intent to withdraw consent to a CORI check.

I understand that the Office of the Inspector General may conduct subsequent CORI checks within one year of the date

this form was signed by me.

By signing below, I provide my consent to a CORI check and affirm that the information provided on Page 2

of this acknowledgement form is true and accurate.

___________________________________________________________

SignatureofCORISubject

_________________________________

Date



___________________________________________________________

Print Nameof CORISubject

2

SUBJECTINFORMATION

Thefieldsmarkedwithanasterisk(*)arerequiredfields.

* FirstName:______________________ ___________________ _______________ MiddleInitial: _________________

* LastName:_________________________________________________________ Suffix(Jr.,Sr.,etc.): _____________

FormerLastName1: _______________________________________________________________________________

FormerLastName2: _______________________________________________________________________________

FormerLastName3: _______________________________________________________________________________

FormerLastName4: _______________________________________________________________________________

* DateofBirth(MM/DD/YYYY): ___________________ PlaceofBirth:________________________________________

* LastSIXdigitsofSocialSecurityNumber: ______‐‐____________ ☐NoSocialSecurityNumber

Sex: _________________ Height: _____ft. _____in. EyeColor:_______________ Race: ______________________

Driver’sLicenseorIDNumber:______________________________________ StateofIssue:____________________

Father’sFullName: ________________________________________________________________________________

Mother’sFullName: _______________________________________________________________________________

CurrentAddress

* StreetAddress:____________________________________________________________________________________

Apt.#orSuite: _____________ *City:__________________________ *State: ________ *Zip:_______________

SUBJECTVERIFICATION

In Person

For OIG Staff:

Theaboveinformationwasverifiedbyreviewingthefollowing

form(s)ofgovernment‐issuedidentification:

_________________________________________________

_________________________________________________

_________________________________________________

Verifiedby:

________________________________________________

Print Name of Verifying Employee

________________________________________________

Signature of Verifying Employee

________________________________________________

Date

Notary

On this ____ day of ___________, 20____, before me, the

undersigned Notary Public, personally appeared

_______________________ (name of document signer) and

proved to me through satisfactory evidence of identification,

which was ______________________ (e.g., Driver’s license,

passport, etc.), to be the person whose name is signed on the

preceding or attached document, and acknowledged to me that

(he)(she) signed it voluntarily for its stated purpose.

______________________________

Signature of Notary Public (Notary

stamp or seal is also required)

________________________

Date my Commission expires

You may submit this form in person to the Office of the Inspector General, at which time you will be required to present a

valid government-issued photo identification. Alternatively, you may submit the form by mail, in which case you must first

have the form notarized and must include with it a photocopy of your valid government-issued photo identification.

Continuing Education Credit Record

For MCPPO Recertification only

Name:

MCPPO Designation:

MCPPO Recertification Date:

Activity

Sponsor/Organization

Begin/End Dates

Category*

Credits

*Category codes (required credits): A - Professional Affiliations (6), B - Professional Contributions (15), C - Education and Training (25)

Fill Online, Printable, Fillable, Blank Mcppo Recertification Application Form (Commonwealth of Massachusetts) Form

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Fillable Mcppo Recertification Application Form (Commonwealth of Massachusetts)

Fill Online, Printable, Fillable, Blank Mcppo Recertification Application Form (Commonwealth of Massachusetts) Form

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