Fillable P rofessional Recommendation for Certification Form

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P rofessional Recommendation for Certification Form

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The P rofessional Recommendation for Certification Form form is 3 pages long and contains:

  • 1 signature
  • 4 check-boxes
  • 17 other fields

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File type: PDF

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P
rofessional Recommendation for Certification Form
Florida Certification Board (FCB)
CBHCMP Upgrade Professional Recommendation for Certification Form
Effective Date: March 2019
DIRECTIONS
This form allows for one individual to provide a recommendation for certification. Provide a separate Recommendation
for Certification Form to each individual who will be completing a Professional Recommendation on your behalf.
Recommendations for certification may not be provided by a relative, any person sharing the same household, or any
person in a romantic, domestic, or familial relationship with the applicant. The same person may not complete more
than one recommendation per applicant per credential.
All information must be TYPED. Handwritten forms will be denied. This is a two-part form.
• P
art One is completed by the applicant and given to the individual providing the recommendation.
• Part Two is completed by the individual providing the recommendation. This individual will submit the completed
recommendation form to FCB by mail, email or fax (see below).
Mail:
Florida Certification Board
Email:
Certification Specialist’s email or
Attn: Certification Operations
admin_assist@flcertificationboard.org
1715 South Gadsden Street
Fax:
850-222-6247
Tallahassee FL 32301
Subject Line:
Recommendation (applicant name)
REQUIREMENT
Professional
Recommendation
Definition
For certification purposes, a professional recommendation is provided by an individual who
has direct knowledge of the applicant’s on-the-job performance.
The professional
recommendation should discuss the applicant’s work performance as it relates to the role
and expectations required of the certification. While teamwork, experience and work ethic
are the types of things discussed, the recommendation should give the FCB an idea of the
type of individual applying for certification. Individuals providing a recommendation may
not be in a subordinate position to the applicant.
P
rofessional Recommendation for Certification Form
Florida Certification Board (FCB)
CBHCMP Upgrade Professional Recommendation for Certification Form
Effective Date: March 2019
A
ll information must be typed. Handwritten forms will be denied.
Part 1: To be completed by the applicant prior to providing to individual for completion.
Applicant Information: Use a separate form for each individual providing a recommendation for certification.
Applicant Name:
Credential Applied For:
Name of Certification Specialist, if known:
Name of Individual Providing the Recommendation:
Part 2: To be completed by the recommender and submitted directly to the FCB.
Last Name:
First Name:
Title:
Employer:
Email Address:
Business Phone:
City:
State:
Zip Code:
Section B: Please describe the nature of your relationship with the applicant, including how you are eligible to provide
the applicant with a recommendation for certification.
P
rofessional Recommendation for Certification Form
Florida Certification Board (FCB)
CBHCMP Upgrade Professional Recommendation for Certification Form
Effective Date: March 2019
Section B Continued: Please describe why you believe the applicant would be a successful member of the profession in
which he or she is seeking certification. Please include specific examples of incidents where you observed the applicant
successfully demonstrating skills expected of a certified professional.
Section C: Attestation
I affirm that all of the information that I have provided on this form and any provided attachments is true, to the best of
my knowledge.
I affirm. I do not affirm.
I affirm that I recommend the applicant listed in Part 1 of this form for certification with the Florida Certification Board.
I affirm. I do not affirm.
Recommender’s Signature
(FCB accepts manual and electronic signatures)
Date
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P rofessional Recommendation for Certification Form

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Completed 22 November 2021

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