Fill - Free fillable STATE OF KANSAS INSTRUCTIONS FOR CCR APPLICANTS Before (Kansas Judicial Branch) PDF form

1

Revised 02/07

STATE OF KANSAS

INSTRUCTIONS FOR CCR APPLICANTS

Please note the following:

• Applicants must qualify under one of the four classifications set forth in question 11 of the application

form. Applicants should indicate by a check which item they are going to qualify under, and evidence

submitted to qualify under question 11 shall be filed in duplicate.

Applicants qualifying under question 11b of the application form should review Supreme Court Rule

309(c).

Applicants completing this form for reciprocal purposes only should also obtain the Certification on

Motion application and complete that application in accordance with the instructions on that application.

• Question 15 of the application form requires names and addresses of persons who have knowledge of the

applicant’s character and integrity. These names should be in addition to the three persons who have

furnished Certificates of Character.

• Three completed “Certificates of Character” forms shall be attached to the application. Relatives, by

marriage or blood, and individuals listed in Question 15 are not acceptable as affiants. Certificates

attached to the second application may be photocopies of the originals.

• All signatures and notary certificates should be completed in blue ink.

• You may photocopy the application form; however, both copies of the application must bear original

signatures and notarizations on page 8.

• Your CCR application, photos, and accompanying documents are to be filed in duplicate at least thirty

(30) days prior to the date of the next examination. Mail to:

Clerk of the Supreme Court

Kansas Judicial Center

301 SW 10

th

Avenue, Room 374

Topeka, Kansas 66612

• The application fee is $125.00 (non-refundable) and may be paid by personal check made payable to the

Clerk, Kansas Supreme Court. The application fee MUST be submitted with your application.

• Keep the Clerk’s Office advised of any change of name, address, or telephone numbers after the filing of

your application.

• Incomplete applications and/or Certificates of Character will be returned to the applicant.

• Applications received after the filing deadline will need to include a motion to waive the filing

deadline. See Rule 307.

• Keep a copy of the complete application form for your files.

Before completing the application form, carefully read the Supreme Court and Board Rules,

particularly Supreme Court Rules 307 and 308 and Board Rules 3 and 6.

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Revised 02/07

CHECKLIST FOR FILING CCR APPLICATION

(This page is to be included as the first page of the application packet.)

Note: Failure to provide ALL the items listed below will cause

your application to be returned.

Please submit your application and accompanying materials in the following order:

____ 1. Filing Fee - $125.00 (non-refundable). Checks should be made payable to the

Clerk of the Supreme Court. Payment must be included with your

application.

____ 2. Checklist for filing CCR application.

____ 3. Application form (submit in duplicate – an original and one exact copy.)

a. Signature on pages eight (8) and nine (9) on both copies – using blue ink.

b. Notarized on pages eight (8) and nine (9) on both copies – using blue ink.

c. Photo placed on page one of the original and duplicate applications.

____ 4. Three original Certificates of Character – signed and notarized. The original

set of certificates should be attached to the original application. Certificates

attached to the second application may be photocopies of the originals.

____ 5. Evidence of Education, Training, or Certification.

____ 6. Supplements or miscellaneous information included that is not listed above.

(List in the space below.)

Date:

Signature

Street Address

City, State, Zip

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Revised 02/07

IN THE SUPREME COURT OF THE STATE OF KANSAS

To the State Board of Examiners of Court Reporters

No. ___________________

(Leave Blank - A number will be

assigned by the Court Reporters’

Board.)

Application of

_____________________________________________________________________

for Certification as a Certified Court Reporter

This photo was taken on __________________________.

(Date and year)

Tape a recent

passport size

photo here.

I, ___________________________________________________, hereby make application (check

one):

(Name as shown on Page 2, Question 1)

____ 1. To take the next regular Kansas examination for Certified Court Reporter;

____ 2. To transfer my RPR or CVR certification into Kansas; or

____ 3. To obtain Kansas certification based on my certification in another state.

(You must request a Certification on Motion Application from our office in

order to complete this process. You may also obtain this application from our

website at www.kscourts.org)

4

Revised 02/07

1. Full Legal Name:

2. Present Address:

Street

City County State Zip

Permanent Address:

Street

City County State Zip

To which address do you wish mail sent? Present ______ Permanent ______

3. Telephone No: Home

Work

Cell (optional)

4. E-mail Address: (optional)

5. Date of Birth:

Social Security Number (optional):

6. State each residence address (including your present address) you have had for the past five years, starting

with the most recent. There should be no gaps in time.

Dates

Street & Number

: City & State: Zip: From: To:

The following questions should be answered in detail. If necessary to make complete answers, attach

separate sheets bearing question numbers corresponding with those below.

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Revised 02/07

7. ________ Are you currently employed?

Yes or No

State name of employer, place of employment, position held, dates of employment and reason for termination of

employment for the past five years, starting with the most recent. Explain any periods of unemployment on the

forms so as to provide continuous documentation. I hereby consent that full disclosures regarding my

employment may be made by the employer to the State Board of Examiners of Court Reporters.

Month and year of beginning and ending employment period:

From:

To:

Name of employer or firm (individual, partnership or corporation)

DO NOT ABBREVIATE

Address:

Street City State Zip

Nature of employer’s business

Position Title ___________________________ Supervisor’s Name:

Present address of employer (if deceased or defunct, give name and address of associate who can verify

employment)

Reason for leaving?

Month and year of beginning and ending employment period:

From:

To:

Name of employer or firm (individual, partnership or corporation)

DO NOT ABBREVIATE

Address:

Street City State Zip

Nature of employer’s business

Position Title ___________________________ Supervisor’s Name:

Present address of employer (if deceased or defunct, give name and address of associate who can verify

employment)

Reason for leaving?

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Revised 02/07

Month and year of beginning and ending employment period:

From:

To:

Name of employer or firm (individual, partnership or corporation)

DO NOT ABBREVIATE

Address:

Street City State Zip

Nature of employer’s business

Position Title ___________________________ Supervisor’s Name:

Present address of employer (if deceased or defunct, give name and address of associate who can verify

employment)

Reason for leaving?

Month and year of beginning and ending employment period:

From:

To:

Name of employer or firm (individual, partnership or corporation)

DO NOT ABBREVIATE

Address:

Street City State Zip

Nature of employer’s business

Position Title ___________________________ Supervisor’s Name:

Present address of employer (if deceased or defunct, give name and address of associate who can verify

employment)

Reason for leaving?

If additional space is needed, please attach a separate sheet using this same format.

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Revised 02/07

8. ________ a. Are you a citizen of the United States?

Yes or No

b. If claiming citizenship, other than by birth, state date naturalized, court and location, and

naturalization number. (Attach a copy of your naturalization card or certificate.)

c. If not a United States citizen, from what country do you claim citizenship?

d. If not a United States citizen, describe your immigration status and provide your alien

registration number and a copy of your resident alien card. If you do not have an alien

registration number or resident alien card, explain.

9. Did you take the October 2003 or any subsequent examination for certification in Kansas? If the answer is

“yes,” did you pass any portion of the examination?

10. Indicate the date and school from which you received your high school diploma.

Date School City State

or completed G.E.D. ______________________.

(Month and Year)

List all business schools, colleges and universities you have attended, dates of attendance, degrees received

and date of graduation.

Graduated?

Dates of Credit Hrs. and/or (Yes or No)

School

: Address: Attendance: Degree Received: and Date:

8

Revised 02/07

11. Before being examined, applicant must furnish evidence of at least ONE of the following items of

education, training, or certificates. Check which one is being submitted.

_____ a. Graduation from and completion of a court reporting course in a business college or other school

licensed or accredited by the State of Kansas or the state where such school is located. (Attach a

copy of your diploma or a letter from the court reporting school stating successful

completion of the course. In addition, attach a letter from the court reporting school,

stating successful completion of at least one 225 word per minute test.)

_____ b. That applicant is certified as a Registered Professional Reporter (RPR) by the National Court

Reporters Association (if seeking certification in Kansas as a shorthand reporter) or certified as a

Certified Verbatim Reporter (CVR) by the National Verbatim Reporters Association (if seeking

certification in Kansas as a voicewriter).

Applicant must request a letter of certification from NCRA or NVRA verifying the RPR or

CVR pass date & status, member in good standing, and the date of applicant’s present

continuing education cycle. This letter should be mailed directly to the Clerk’s Office from

the association.

_____ c. Applicant has had at least two years of experience in making verbatim records of judicial or

related proceedings in the system of verbatim reporting which the applicant seeks certification.

(Attach documentation from the court or other employer in which the two years of

experience have been served, including the name of the employer, the type of proceedings

recorded, and the dates of employment.)

_____ d. That applicant holds a valid and unrevoked certificate as a certified shorthand reporter or certified

court reporter issued under the laws of any other State or Territory of the United States. (Attach

copy of certificate.)

12. My system of reporting is _______________________________, and I follow the principles of that system

so that others writing the system can readily read my notes.

13. Do you currently have any condition or impairment (including, but not limited to, substance abuse, alcohol

abuse, or a mental, emotional, or nervous disorder or condition) which in any way currently affects, or if

untreated could affect, your ability to serve as a Certified Court Reporter in a competent manner?

Yes _____ No _____ If “yes,” explain.

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Revised 02/07

14. ________ a. Has a court ever found that you violated a fiduciary duty?

Yes or No

________ b. Have you ever been adjudicated a juvenile offender?

Yes or No

________ c. Have you ever been convicted of a felony or misdemeanor (except traffic

Yes or No infractions)?

________ d. Are you presently on probation, parole, or diversion for any violation,

Yes or No including a misdemeanor?

15. The following five persons have known me for two (2) or more years, and have knowledge of my character,

integrity, morality, general reputation, and record for meeting my financial obligations promptly. I consent

that inquiry may be made of them with full disclosure by them concerning these matters. (Do not list

relatives, by marriage or blood, or those who have executed the form “Certificate of Character.”)

Print name, complete address, zip code, phone number, and years known.

Phone Number of

Name

: Address: Number: years known:

1.

2.

3.

4.

5.

16. If applying to take the next regular examination, list the equipment which you will bring to the examination.

(The Board of Examiners of Court Reporters furnishes no equipment or paper for the examination.)

If you answer any part of question 14 “yes,” attach a statement giving dates, court or proceeding, the

full facts, including disposition, and the name and address of the person or entity in possession of the

record.

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Revised 02/07

17. If seeking Kansas certification based on certification in another state (See Rule 309(d)), provide proof of the

following:

a. passage of another state’s examination equivalent to or more stringent than the current Kansas exam, and

b. proof of passage of the other state’s exam within three years prior to application in Kansas or proof of

five years’ experience as a court reporter.

Submit the Application for Certification on Motion to the licensing agency of the state from which you

are requesting certification recognition. Please read the instructions on that application carefully.

You must complete page 1 and send it to the licensing agency for them to complete their portion.

BOTH PAGES OF THAT APPLICATION MUST BE RECEIVED DIRECTLY FROM THE

LICENSING AGENCY OF THE STATE FROM WHICH YOU ARE REQUESTING

CERTIFICATION RECOGNITION.

I

SPECIFICALLY AUTHORIZE THE BOARD OF EXAMINERS OF COURT REPORTERS OF THE STATE OF KANSAS

OR ITS

DESIGNEE(S) TO OBTAIN ANY INFORMATION FROM MY OFFICIAL RECORD OF ANY PAST OR PRESENT

EMPLOYER WHICH MAY HAVE A BEARING ON MY CHARACTER AND FITNESS

, AND I HEREBY CONSENT TO AND

AUTHORIZE THE RELEASE OF ANY SUCH INFORMATION

.

I

UNDERSTAND THAT I HAVE A CONTINUING OBLIGATION TO ADVISE THE OFFICE OF CLERK OF THE

SUPREME COURT OF EVENTS WHICH WOULD CHANGE MY RESPONSE TO ANY QUESTION ON THIS

APPLICATION FOR EXAMINATION FOR CERTIFICATE AS CERTIFIED COURT REPORTER.

______________________________________________________

Applicant’s Signature (

SIGN IN BLUE INK)

STATE OF ____________________________

ss:

COUNTY OF __________________________

I, _________________________________, the applicant above named, do solemnly swear that I signed the

above and foregoing application; that I have read the application; and that all statements therein made are true. So

help me God.

_______________________________________

Applicant’s Signature (SIGN IN BLUE INK)

Subscribed and sworn to before me this _____ day of ______________________, 20 ____.

_______________________________________

Notary Public

My commission expires: __________________________

11

Revised 02/07

BOARD OF EXAMINERS OF COURT REPORTERS OF THE STATE OF KANSAS

AUTHORIZATION AND RELEASE

I, , born at ,

(City)

, on ,

(State) (Date of Birth)

having filed an application for certification as a court reporter in the State of Kansas, hereby consent to have an

investigation made as to my moral character, professional reputation, and fitness for certification by the

Supreme Court as a court reporter in the State of Kansas, all of which will be reported only to the Board of

Examiners of Court Reporters of the State of Kansas. I agree to give any further information which may be

required in reference to my past record. I understand that the contents of my character report are confidential.

I hereby authorize and request every educational, or other institution, hospital, or other medical facility,

physician, person, firm, company, corporation, governmental agency, police authority, court, association or

institution having control of any documents, records and other information requested by the Board of Examiners

of Court Reporters of the State of Kansas to furnish to them such information or records, including documents,

certification files, medical records and physician’s reports, credit history reports, all criminal history records,

and any other pertinent data so requested, and to permit them or any of their agents or representatives to inspect

and make copies of such documents, records, and other information.

I hereby authorize the National Personnel Records Center, St. Louis, Missouri, or other custodian of my military

record to release to the Board of Examiners of Court Reporters of the State of Kansas any requested information

or photo copies from my military personnel and related medical records. This could include a photocopy of my

DD form 214, Report of Separation. My serial number and branch of the military were:

.

I hereby release, discharge and exonerate the Board of Examiners of Court Reporters of the State of Kansas,

their agents and representatives, and any party furnishing information from liability arising out of the

furnishing or inspection of such documents, records, and other information or the investigation made by the

Board of Examiners of Court Reporters of the State of Kansas.

I hereby acknowledge that I am executing this document and do hereby authorize that it may be copied by the

Board of Examiners of Court Reporters of the State of Kansas and that said copies may be used and accepted as

originals in the same manner and for the same purpose as if they were the original of this document.

I have read the foregoing document and have answered all questions. The answers are complete and truthful of

my own knowledge.

Signature of Applicant (SIGN IN BLUE INK)

STATE OF )

COUNTY OF )

Subscribed and sworn to before me this day of , 20 .

Notary Public (SIGN IN BLUE INK)

My Commission expires:

CERTIFICATE OF CHARACTER

Affiants must have known the applicant for a period of not less than 2 years

.

(Relatives, by marriage or blood, are not acceptable as affiants,

nor are the individuals listed in Question 15.)

In the Matter of the Application of:

___________________________________________________________

F

OR APPLICATION FOR CERTIFICATION AS CERTIFIED COURT REPORTER

1. Name of Attesting Party _____________________________________________________________

Residence Address _________________________________________________________________

Street City State Zip

Phone Number __________________ Occupation ____________________________________

2. How long have you known the applicant? _______________________________________________

3. What relationships (such as employer, social friend, co-worker, and the like) have you had with the applicant

which have aided you in forming any opinion of his/her character?

4. Do you believe the applicant to be of good moral character and habits and one in whom trust and confidence

can be fully reposed? ____Yes ____No If your answer is “no”, explain in detail.

5. If you desire, please expand upon any of the foregoing answers or add any comments or information which

you believe will assist the Kansas Board of Court Reporters.

Date:______________________

Signature of Affiant (

SIGN IN BLUE INK)

STATE OF ___________________________

ss:

COUNTY OF _________________________

Subscribed and sworn to before me, a Notary Public in and for the above county and state, this _____ day of

_______________________, 20____.

_______________________________________

Notary Public (SIGN IN BLUE INK)

My commission expires: __________________________

CERTIFICATE OF CHARACTER

Affiants must have known the applicant for a period of not less than 2 years

.

(Relatives, by marriage or blood, are not acceptable as affiants,

nor are the individuals listed in Question 15.)

In the Matter of the Application of:

___________________________________________________________

F

OR APPLICATION FOR CERTIFICATION AS CERTIFIED COURT REPORTER

6. Name of Attesting Party _____________________________________________________________

Residence Address _________________________________________________________________

Street City State Zip

Phone Number __________________ Occupation ____________________________________

7. How long have you known the applicant? _______________________________________________

8. What relationships (such as employer, social friend, co-worker, and the like) have you had with the applicant

which have aided you in forming any opinion of his/her character?

9. Do you believe the applicant to be of good moral character and habits and one in whom trust and confidence

can be fully reposed? ____Yes ____No If your answer is “no”, explain in detail.

10. If you desire, please expand upon any of the foregoing answers or add any comments or information which

you believe will assist the Kansas Board of Court Reporters.

Date:______________________

Signature of Affiant (

SIGN IN BLUE INK)

STATE OF ___________________________

ss:

COUNTY OF _________________________

Subscribed and sworn to before me, a Notary Public in and for the above county and state, this _____ day of

_______________________, 20____.

_______________________________________

Notary Public (SIGN IN BLUE INK)

My commission expires: __________________________

CERTIFICATE OF CHARACTER

Affiants must have known the applicant for a period of not less than 2 years

.

(Relatives, by marriage or blood, are not acceptable as affiants,

nor are the individuals listed in Question 15.)

In the Matter of the Application of:

___________________________________________________________

F

OR APPLICATION FOR CERTIFICATION AS CERTIFIED COURT REPORTER

11. Name of Attesting Party _____________________________________________________________

Residence Address _________________________________________________________________

Street City State Zip

Phone Number __________________ Occupation ____________________________________

12. How long have you known the applicant? _______________________________________________

13. What relationships (such as employer, social friend, co-worker, and the like) have you had with the applicant

which have aided you in forming any opinion of his/her character?

14. Do you believe the applicant to be of good moral character and habits and one in whom trust and confidence

can be fully reposed? ____Yes ____No If your answer is “no”, explain in detail.

15. If you desire, please expand upon any of the foregoing answers or add any comments or information which

you believe will assist the Kansas Board of Court Reporters.

Date:______________________

Signature of Affiant (

SIGN IN BLUE INK)

STATE OF ___________________________

ss:

COUNTY OF _________________________

Subscribed and sworn to before me, a Notary Public in and for the above county and state, this _____ day of

_______________________, 20____.

_______________________________________

Notary Public (SIGN IN BLUE INK)

My commission expires: __________________________

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