Current through Register Vol. 39, No. 6, September 16, 2024
(a) Pursuant to
G.S.
90B-7, any person desiring to obtain a
certificate or license from the Board shall make application to the Board.
Applications not completed within two years of submission to the Board shall be
denied. Application forms and instructions may be found on the Board's website
at https://www.ncswboard.org.
(b) All applications for certification or
licensure shall contain the following:
(1) the
applicant's contact information;
(2) the social security number of the
applicant;
(3) the requested
designation of licensure or certification type;
(4) educational history and degree
attainment;
(5) the names and
contact information of three persons supplying professional reference forms in
support of the applicant's application, as well as the length of time that the
persons have known the applicant;
(6) employment history;
(7) whether the applicant has ever been
certified, licensed, or registered to practice social work by the Board, by
another occupational Board, or in another state/jurisdiction and, if so:
(A) what credential was held;
(B) in what state/jurisdiction;
(C) the issuance date and expiration date;
and
(D) what examinations were
taken to obtain said certification, licensure, or registration;
(8) whether the applicant has ever
had a credential denied, limited, reprimanded, suspended, or revoked;
(9) whether the applicant has ever been
convicted of a felony or misdemeanor under any laws;
(10) whether any criminal charges are pending
against the applicant;
(11) whether
any court, board, agency, or professional organization has found the applicant
guilty of misconduct, unprofessional conduct, dishonest or fraudulent practice,
or incompetent practice;
(12)
whether any charges are pending against the applicant before any court, board,
agency, or professional organization for unprofessional conduct, dishonest or
fraudulent practice, or incompetent practice;
(13) three professional references, as
prescribed in
21 NCAC
63 .0204, provided in a sealed envelope with
the signature of the reference over the sealed closure;
(14) official score reports showing passage
of the required examination, as prescribed herein and in
21 NCAC
63 .0301, provided from the examination
testing provider;
(15) official
transcripts, as prescribed in
21 NCAC
63 .0203, provided either from the
institution directly to the Board or from the applicant to the Board in an
envelope that is sealed by the institution;
(16) the applicant's affirmation that:
(A) the applicant has read the North Carolina
General Statute 90B Social Work Certification and Licensure Act, including the
Board's rules, ethical guidelines, and disciplinary procedures, which are
available on the Board's website at
https://www.ncswboard.org;
(B) the information provided by the applicant
in the application is true;
(C) the
applicant consents to a criminal history record check; and
(D) the applicant has read and understands
the public notice statement on employee misclassification that is set forth in
the application and has disclosed any investigations for employee
misclassification, and its results, over the preceding 12-month period, as
prescribed by
G.S.
143-789; and
(17) the application fee, as prescribed in
21 NCAC
63 .0208.
(c) In addition to the items set forth in
Paragraph (b) of this Rule, applicants for certification as a certified social
work manager shall provide a completed CSWM Administrative Supervision Form, as
prescribed in Paragraph (e) of this Rule, and an Employment Verification Form,
as prescribed in Paragraph (f) of this Rule, to demonstrate supervised
administrative experience attained in the preceding six years.
(d) Applicants for licensure as a licensed
clinical social worker who are licensed by the Board as licensed clinical
social worker associates at the time of application shall provide to the Board
the LCSW Short-Form Application, which contains the following:
(1) the applicant's name, the number of the
applicant's licensed clinical social worker associate license, and contact
information;
(2) the signature of
the applicant and the applicant's LCSW supervisor;
(3) whether the LCSW supervisor recommends
that the applicant continue supervised clinical practice at the LCSWA level or
recommends the applicant for LCSW licensure;
(4) the applicant's certification that:
(A) the applicant has completed the
requirements to obtain licensure in North Carolina as a LCSW as set forth in
G.S.
90B-7(d);
(B) the applicant has read the North Carolina
General Statute 90B Social Work Certification and Licensure Act, and the
Board's rules, ethical guidelines, and disciplinary procedures, which are
available on the Board's website at
https://www.ncswboard.org,and agrees to
comply with them;
(C) the
information provided by the applicant in the application is true;
(D) the applicant has not violated any of the
Board's governing statutes or rules; and
(E) the applicant has not been convicted of a
misdemeanor or felony crime since submitting his or her initial application for
associate licensure;
(5)
the application fee, as prescribed in
21 NCAC
63 .0208; and
(6) a list of all continuing education hours
taken since the applicant was licensed as a LCSWA or since renewal of LCSWA
licensure that provides the name of the course taken, the date on which the
course was taken, the length of the course taken, and whether the course taken
was distance learning or for ethics.
(e) A CSWM Administrative Supervision Form
shall contain the following:
(1) the name of
the applicant and his or her supervisor;
(2) the applicant's position;
(3) a description of the applicant's
administrative duties and responsibilities for the employer;
(4) where the applicant worked during the
time that supervision was provided to the applicant;
(5) dates during which the applicant was
employed;
(6) total number of hours
during which the applicant was employed;
(7) dates during which the supervisor
provided administrative supervision;
(8) total number of hours during which the
supervisor provided individual administrative supervision to the
applicant;
(9) total number of
hours during which the supervisor provided group administrative supervision to
the applicant;
(10) total combined
hours of individual and group hours provided to the applicant; and
(11) the supervisor's certification that the
information set forth in the CSWM Administrative Supervision Form is correct
and that the supervisor is certified with the Board on at least one level and
has a minimum of two years of administrative experience in a social work or
mental health setting.
(f) An Employment Verification Form shall be
completed for each place of employment where the applicant has worked over the
preceding six years and shall contain the following:
(1) the applicant's name and contact
information;
(2) the applicant's
license number, if a license is held;
(3) the name and contact information of the
applicant's place of employment;
(4) the title of the applicant's
position;
(5) whether the applicant
is authorized to provide clinical services on behalf of the employer;
(6) the applicant's duties for the employer,
as documented in a job description on the employer's letterhead;
(7) the name and license number of the
applicant's clinical supervisor;
(8) whether the applicant's supervisor
provided supervision to the applicant in person or remotely;
(9) the date of the applicant's
employment;
(10) whether the
applicant was employed full-time, part-time, or pro re nata;
(11) whether the applicant is paid a fee or
salary for services performed; and
(12) the employer's signature, contact
information, and the date completed.
On the Employment Verification Form, the applicant shall
provide the information requested in Subparagraphs (f)(1)-(2) of this Rule and
the applicant's employer shall provide the information requested in
Subparagraphs (f)(3)-(12) of this Rule.
Authority
G.S.
90B-6;
90B-7;
93B-8.1(c);
Eff. August 1, 1987;
Temporary Amendment Eff. October 1,
1999;
Amended Eff. July 1, 2000;
Pursuant to
G.S.
150B-21.3A, rule is necessary without
substantive public interest Eff. September 19, 2015;
Amended Eff.
October 1, 2021.
