CALIFORNIA CERTIFICATION BOARD OF CHEMICAL by yaofenjin

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									               Counselor Certification Application for: California Certification Board of Chemical Dependency Counselors (CCBCDC)
                  Mailing Address: P.O Box 40043 Downey, CA 90239               Telephone. (562) 927-5143 Fax: 562-392-4682



                                                   CERTIFICATION APPLICATION




Only Registered Counselors or Individuals who meet the following requirements must submit this application:
Individuals whose have completed all .Certification Application Requirements in accordance to Section: § 13040. Requirements
for Initial Certification of AOD Counselors or Section: § 13025. Requirements for Certification by testing of the State Of
California Alcohol and Drug Programs Administration.

Be sure to include this form with your application. Use this Documentation Checklist to ensure that you are submitting all
the required documents.

                                          CCBCDC DOCUMENTATION CHECK LIST

    Date: _____________________

    Initial Certification Application: ____________                Renewal Certification Application: ____________

    Counselor Name: ____________________________________________                       SSN: _______________________________

    1.   Signed Application                                                                                _______ _______
    2.   Copy of Government issued Identification                                                          _______ _______
    3.   Copy of Social Security Card                                                                      _______ _______
    4.   Qualifying Employment Experience Form                                                             _______ _______
    5.   Qualifying Educational experience form                                                            _______ _______
    6.   Qualifying Continuing Education Form (Only for Re-Certification Candidates)                       _______ _______
    7.   Educational Experience Support Documents (transcripts, diploma. Certificate, etc.)                _______ _______
    8.   Professional References                                                                           _______ _______
    9.   Colleague Endorsement Form 1                                                                      _______ _______
    10. Colleague Endorsement Form 2                                                                       _______ _______
    11. Supervisor Evaluation Form                                                                         _______ _______
    12. Supervisor Endorsement Form                                                                        _______ _______
    13. Supervised Experience Summary          (Demonstrate 2,080 Hours)                                   _______ _______
    14. Ethics Certification and Attestation Form                                                          _______ _______
    15. Certification of Accuracy, Agreement and Release of Authorization                                  _______ _______
    16. Acknowledgement of Code of Ethics & Code of Conduct                                                _______ _______
    17. Copy of Resume/Biography                                                                           _______ _______
    18. Application Fees $240.00                                                                           _______ _______
    19. Examination Fees $150.00                                                                           _______ _______
    (Do not enclose Examination Fees, until you receive notification of eligibility to sit for examination.)
                   Important Notice: All forms must be completed to their entirety to avoid delay in application processing.




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                Counselor Certification Application for: California Certification Board of Chemical Dependency Counselors (CCBCDC)
                   Mailing Address: P.O Box 40043 Downey, CA 90239               Telephone. (562) 927-5143 Fax: 562-392-4682

INTRODUCTION
The California Certification Board of Chemical Dependency Counselors (CCBCDC) is an independent not-for profit recognized
certifying board by the State of California Alcohol and Drug Programs Administration (ADP). The mission of our organization is
to become the standard of excellence by which California recognizes certified chemical dependency counselors.
Purpose / Objectives
 To promote positive change in the lives of alcohol and drug dependent people.
 To improve the quality and accountability of the professional counselors.
 To enhance the profession of substance abuse counseling.
Strategies
 Define, promote, and maintain strict, structured, measurable, and fair standards for California substance abuse counselors.
 Create, promote, and maintain a community-based support system for the California substance abuse counseling industry.
 Define, promote, and maintain the highest level of professionalism and ethical standards for California substance abuse
    counselors.
 Identify and promote continuing improvement of quality in the methodologies used by California substance abuse counselors.
STATE REGULATIONS
The AOD Counselor is the result of the State of California’s regulatory action that adopts Chapter 8 (commencing with Section
13000), and amends Sections 9846, 10125, and 10564 of Division 4, Title 9 of the California Code of Regulations by establishing
requirements for certification of staff who provide counseling services in alcohol and other drug (AOD) programs.
AOD Counselor Code or Regulations, Section 13005
“Counseling services” means any of the following activities:
(A) Evaluating participants’, patients’, or residents’ AOD treatment or recovery needs, including screening prior to admission,
intake, and assessment of need for services at the time of admission;
(B) Developing and updating of a treatment or recovery plan;
(C) Implementing the treatment or recovery plan;
(D) Continuing assessment and treatment planning;
(E) Conducting individual counseling sessions, group counseling sessions, face-to-face interviews, or counseling for families,
couples, and other individuals significant in the life of the participants, patients, or residents; and
(F) Documenting counseling activities, assessment, treatment and recovery planning, clinical reports related to treatment
provided, progress notes, discharge summaries, and all other client related data.
The certification will establish standards for education, experience, conduct, and complaint investigation for AOD counselors,
improving the quality of the services provided. These regulations are necessary to protect the health, safety, and welfare of AOD
participants, patients, and residents.
AOD COUNSELOR SCOPE OF PRACTICE
Alcohol and other drug counselors work very closely with program participants, patients, and residents, and provide many critical
services including assessments, counseling, treatment planning, and case management. However, counselors are not currently
required to be certified or to have a minimum amount of education or experience. Most treatment programs use or employ a
mixture of AOD counselors who have some formal education or personal experience with alcoholism, drug addiction, and
recovery.
ABOUT THE APPLICATION PROCESS
Before you submit your application and documentation, make copies of all of your documents. All materials become the property
of the CCBCDC upon receipt. Copies are not released back to the applicant or third party.
Make sure all documents are completely filled out, and signed and dated where applicable. Ink signatures are required on the
application and all forms. If you make an error, do not use white-out. Mark through the error, write the correction above or
beside it, and initial correction.
It is your responsibility to ensure that the application and all supporting documents have been properly completed and that the
information provided is accurate. Your careful attention will enable prompt and efficient processing. Applicants that are found to
have accurate and untruthful responses may be denied.
When the all Certification Application requirements are met, applicants will be notified by mail about their availability to sit for
the CCDC Examination. Applicants my respond to this notification by submitting a Test Registration Form. our website and
faxing or mailing it to our office including all testing fees payable by credit card, cashiers check or money order.
Please make sure that you attach a copy of a Government issued Identification card and Social Security Card.
Applications may not be submitted via fax. Send your application and payment to: The CCBCDC Attn.:
Certification/Registration P.O Box 40043 Downey, CA 90239       Telephone. (562) 927-5143




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                Counselor Certification Application for: California Certification Board of Chemical Dependency Counselors (CCBCDC)
                   Mailing Address: P.O Box 40043 Downey, CA 90239               Telephone. (562) 927-5143 Fax: 562-392-4682
ELIGIBILITY REQUIREMENTS
To be eligible for the CCDC (Certified Chemical Dependency Counselor) Examination by the CCBCDC, an applicant must fulfill
the following requirements:
Requirements for Certification of AOD Counselors
(California Code of Regulations Chapter 8, subchapter 3, Section 13040)
§ 13040. Requirements for Initial Certification of AOD Counselors.
Prior to certification as an AOD counselor, the certifying organization shall require each registrant to:
(a) Complete a minimum of 155 documented hours of formal classroom AOD education, which shall include at least the
following subjects:
 (1) The curriculum contained in “Addiction Counseling Competencies: The Knowledge, Skills, and Attitudes of Professional
Practice”, Technical Assistance Publication Series 21(TAP 21), published by the Substance Abuse and Mental Health Services
Administration, United States Department of Health and Human Services, Printed 2006 Reprinted 2007.
 (2) Provision of services to special populations such as aging individuals; individuals with:
          Co-occurring disorders (e.g., alcoholism and mental illness)
          Individuals with post traumatic stress disorder [PTSD]
          Individuals with disabilities
          Diverse populations
          Individuals with cultural differences
          Individuals on probation/parole (Criminal Justice)
(3) Ethics;
(4) Communicable diseases including tuberculosis, HIV disease, and Hepatitis C; and
(5) Prevention of sexual harassment;
          (b) Complete a minimum of 160 documented hours of supervised AOD training based on the curriculum contained in
          TAP 21 [as defined in (a) of this regulation] and supervised on-site by an AOD counselor who has been licensed or
          certified pursuant to this Chapter. As used in this regulation, “supervised” means that the individual supervising the
          training shall:
          (1) Be physically present and available on site or at an immediately adjacent site, but not necessarily in the same room at
          all times, and:
          (2) Document in the registrant’s record that the registrant has completed the supervised training required by this
subsection.
          (c) Complete, an additional 2,080 or more documented hours of paid or unpaid work experience providing counseling
          services in an AOD program prior to, after, or at the same time as completion of the education required in (a) of this
          regulation and the supervised AOD training required in (b) of this regulation.
          (d) Obtain a passing score on the Chemical Dependency Counselor Certification examination.
WHAT HAPPENS TO YOUR APPLICATION AFTER IT REACHES THE CCBCDC
1. When your application arrives at the CCBCDC, your application fee is posted to your account and your application
   information is entered into the CCBCDC database.
2. After payment processing, your application is then issued a Registered Intern Number (RIN). RIN numbers are only valid for
   two years.
3. After the application is reviewed you will be notified of the results in writing. You will also receive a Registered Intern
   Verification Document suitable for posting in public view.
4. If you are eligible to sit for the Chemical Dependency Counselor Certification Exam you will be notified in writing. You will
   also receive a registration testing date and a study guide order form.
5. It will take 2 to 8 weeks to receive a reply from the CCBCDC.
Please note that incomplete applications will take longer to process.

The CCBCDC holds incomplete applications open for a two-year period: During that time, every Candidate has the
opportunity to rectify any deficiencies.

LENGTH OF CERTIFICATION AND ANNUAL MAINTENANCE FEE
Registration, Certification or Re-Certification Credentials are valid for a period of two years.
The initial fee of $240.00 is applicable to all new applications.

EXAMINATION FEES
Examination fees are applicable to all candidates who are eligible to sit for the examination after completing all requirements of
the Certification Application.
Fees $150.00

RE-CERTIFICATION REQUIREMENTS
Are available at our website at www: www.californiacertification.org. Or you can contact our office at 562-927-5143 for
additional information.
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                Counselor Certification Application for: California Certification Board of Chemical Dependency Counselors (CCBCDC)
                   Mailing Address: P.O Box 40043 Downey, CA 90239               Telephone. (562) 927-5143 Fax: 562-392-4682

                            CERTIFIED CHEMICAL DEPENDENCY COUNSELOR APPLICATION




                                                               COVER FORM


Date:
Initial Registration Application Initial Certification Application Renewal Certification Application 
First Name, Middle Name , Last Name:
Counselor Certification Number (CCDC):                               Date Issued: _________________________
Date of Birth:____/_____/_____ Marital Status: Single  Married Divorced Separated                                Widow
Drivers License #_____________________State: ________ Social Security Number: ___________________________
Check Only One: Are you a United States Citizen: Yes               Are you a United States Resident: Yes 

Have you applied with this board in the past: Yes  No
Mailing Address (No P.O Boxes):______________________________________________________________________
City:______________________________________________________ State: ________Zip________
Day Telephone Number: ________________________Mobile Telephone Number:_________________________
Evening Telephone Number:_____________________________ Work Telephone Number:_____________________
E-Mail Address:__________________________ Business E-Mail Address: ____________________________
Race as defined by the US Census Bureau (Check One)
American Indian or Alaska Native Black or African American Native Hawaiian or Other Pacific Islander 
Asian  White (Non-Hispanic)  Hispanic or Latino  Other  ___________________________________

I have reviewed the minimum requirements for certification and I verify that I am eligible to apply. I understand that practicing
within my scope of training is an ethical responsibility of all processional counselors.


____________________________________                                ____________________________________
Applicant Signature                                                 Date
********************************************************************************************************
                                                         CCBCDC USE ONLY
Date Received: ____________ Reviewing Officer: _________________________________

Status: Date Approved _____________Approved: _______                Date Denied ___________Denied: _______

Pending Additional Information/Verification: _______ Check/Money Order # _____________________________________
********************************************************************************************************

  All questions on the application package must be acknowledged either by a response or N/A where applicable.




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                Counselor Certification Application for: California Certification Board of Chemical Dependency Counselors (CCBCDC)
                   Mailing Address: P.O Box 40043 Downey, CA 90239               Telephone. (562) 927-5143 Fax: 562-392-4682




                                         QUALIFYING EMPLOYMENT EXPERIENCE



Candidate Name:________________________________________________________________________
Date of request:_________________________________________________________________________
Agency Name:__________________________________________________________________________
Address:_______________________________________________________________________________
City: ______________________________________ State: ________Zip________ County: ___________

Please send a copy of this request including request date.

I am applying to the California Certification Board of Chemical Dependency Counselors (CCBCDC) for the
Certified Chemical Dependency Counselor (CCDC) Credential. I am required to provide documentation for
a minimum of 2,080 hours of addiction counseling experience at no less than 40 hours per week.

Please complete the information below and return this form to me. You can also mail this form to:
          CALIFORNIA CERTIFICATION BOARD OF CHEMICAL DEPENDENCY COUNSELORS (CCBCDC)
                Mailing Address: P.O Box 40043 Downey, CA 90239 Telephone. (562) 927-5143

______________________________________                              ___________________________
Candidates Signature                                                Date

  INFORMATION BELOW MUST BE COMPLETED BY EXPERIENCE VERIFIER (NOT CANDIDATE)

To the person verifying experience: Please complete all information below. If you make an error, do not
use white-out. Mark through the error, write the correction above beside it, and initial the correction.
I verify that during a time span of _____________________ (mm/yy) to __________________ (mm/yy),
the Candidate named above was:
Employed in the position of: _________________________________________________
Self-Employed (If self Employed, please provide verification).
Example: Business License, Federal ID Number, Other related information.
I further verify that during the time span I have specified above, the Candidate spent ___________________
hours per week working within the AOD Counseling field.
To the person verifying experience: please provide the following information about yourself. To ensure
accuracy, please print all information.

1. Verifier’s Name:
   ____________________________________________________________________________________
2. Agency/Institution where you worked with Candidate:
   ____________________________________________________________________________________
3. Your title at agency/institution where you worked with Candidate:
   ____________________________________________________________________________________
4. Your current telephone number (required)
   ____________________________________________________________________________________
Alternate Employment Verifications may be approved on a case-by-case basis. If seeking approval for an Alternate Employment
Verification, Candidates should request, in writing, a special review of their Employment Verification.

  All questions on the application package must be acknowledged either by a response or N/A where applicable.


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                Counselor Certification Application for: California Certification Board of Chemical Dependency Counselors (CCBCDC)
                   Mailing Address: P.O Box 40043 Downey, CA 90239               Telephone. (562) 927-5143 Fax: 562-392-4682

                                         QUALIFYING EMPLOYMENT EXPERIENCE



High School Graduate: Yes _____ No ______ High School Graduation Name: _______________________________________
City: _______________________________________ State _______________________ Year: __________________________
State of California AOD Counselor Education Requirement
Subchapter 3. Requirements for Certification of AOD Counselors, § 13040. Requirements for Initial Certification of AOD
Counselors.
Prior to certification as an AOD counselor, the certifying organization shall require each registrant to:
(a) Complete a minimum of 155 documented hours of formal classroom AOD education, which shall include at least the
following subjects: (1) The curriculum contained in “Addiction Counseling Competencies: The Knowledge, Skills, and Attitudes
of Professional Practice”, Technical Assistance Publication Series 21(TAP 21), published by the Substance Abuse and Mental
Health Services Administration, United States Department of Health and Human Services, Printed 2006 Reprinted 2007. If you
are not sure your coursework meets the current educational requirements, you are encouraged to request a pre-review of
coursework. To request a pre-review, send a letter specifying the credential(s) for which you intend to apply along with a legible
copy of all graduate transcripts and the nonrefundable $80.00 fee to:
                      The California Certification Board of Chemical Dependency Counselors
                                       Attn: Education Review Department
          CALIFORNIA CERTIFICATION BOARD OF CHEMICAL DEPENDENCY COUNSELORS (CCBCDC)
          Mailing Address:            P.O Box 40043 Downey, CA 90239                          Telephone. (562) 927-5143
This is a pre-review of coursework only and does not guarantee approval to sit for the Chemical Dependency Counselor
Certification Exam. Please allow at least six to eight weeks for a written reply. This pre-review fee cannot be applied to your
application fee. This is not a pre-review for your state credentialing process. Do not apply for certification prior to receiving the
results of your pre-review.
________________________________________________________________________________________________________
For education verification please include the following documentation:
A) Official Transcripts from education institution indicating completion of course (Sealed official transcripts must be
sent to CCBCDC address above by the education institution)
B) Copy of award of degree, certificate, diploma, etc.
Post Secondary Institution Name: ___________________________________________________________________________
Address: ________________________________________________________________________________________________
Year Graduated:_______________________ Area of Education: ___________________________________________________
(Check One) * Type of Degree: ____________ Certificate: _______________ Diploma: __________
Transcript Request Date: ___________ Educational Institution Phone Number: ____________________________


College Name: ___________________________________________________________________________________________
Address: ________________________________________________________________________________________________
Year Graduated: ________________                Area of Education:_____________________________________________________
(Check One) * Type of Degree: ____________ Certificate: _______________ Diploma: __________
Transcript Request Date: ___________ Educational Institution Phone Number: ____________________________

University Name: _______________________________________________________________________________________
Address: _______________________________________________________________________________________________
Year Graduated:________________                 Area of Education:____________________________________________________
(Check One) * Type of Degree: ____________ Certificate: _______________ Diploma: __________
Transcript Request Date: ___________ Educational Institution Phone Number: ____________________________

  All questions on the application package must be acknowledged either by a response or N/A where applicable.




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               Counselor Certification Application for: California Certification Board of Chemical Dependency Counselors (CCBCDC)
                  Mailing Address: P.O Box 40043 Downey, CA 90239               Telephone. (562) 927-5143 Fax: 562-392-4682


                                                          REFERENCES

List references of your choosing who have direct knowledge of your work experience. Please furnish the names, mailing
addresses and telephone numbers of all references provided.
1. Last Name, First Name:___________________________________________________________________________________
Employer: _______________________________________________________________________________________________
Address:____________________________________________________ City:__________________ State: ________Zip______
Phone Number: ________________ In what capacity did you work with this person? __________________ Years ___________




2. Last Name, First Name:___________________________________________________________________________________
Employer: _______________________________________________________________________________________________
Address:____________________________________________________ City:__________________ State: ________Zip______
Phone Number: ________________ In what capacity did you work with this person? __________________ Years ___________




3. Last Name, First Name:___________________________________________________________________________________
Employer: _______________________________________________________________________________________________
Address:____________________________________________________ City:__________________ State: ________Zip______
Phone Number: ________________ In what capacity did you work with this person? __________________ Years ___________




4. Last Name, First Name:___________________________________________________________________________________
Employer: _______________________________________________________________________________________________
Address:____________________________________________________ City:__________________ State: ________Zip______
Phone Number: ________________ In what capacity did you work with this person? __________________ Years ___________




_________________________________________________                            ___________________________
Candidates Position                                                          Name of Agency/Institution




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                Counselor Certification Application for: California Certification Board of Chemical Dependency Counselors (CCBCDC)
                   Mailing Address: P.O Box 40043 Downey, CA 90239               Telephone. (562) 927-5143 Fax: 562-392-4682

                                            COLLEAGUE ENDORSEMENT FORM 2




Candidate Name: _____________________________________________Candidate Position: ___________________________

Facility Name: ______________________________________________________ Phone Number: _______________________

Colleague Name: _________________________________ Colleagues Position: _______________________________________

Colleague endorsers must be employed within the AOD field and have first hand knowledge of Candidates work performance.

During the time period from _______________________________ to _______________________________________.
Please comment on:

1. Candidate’s knowledge of the substance abuse treatment process.
________________________________________________________________________________________________________
________________________________________________________________________________________________________
2. Candidate’s ability to work independently.
________________________________________________________________________________________________________
________________________________________________________________________________________________________
3. Candidate’s suitability for private practice.
________________________________________________________________________________________________________
________________________________________________________________________________________________________
4. Would you recommend that this Candidate
explain:
________________________________________________________________________________________________________
________________________________________________________________________________________________________

If you do not meet this criterion, please return this form to the candidate so that she/he may ask someone else for this
endorsement.
To the California Certification Board of Chemical Dependency Counselors (CCBCDC):

I hereby state that I have been professionally acquainted with the above named Candidate for _________ years _________
months and am not related to this candidate. To the best of my knowledge and belief, this Candidate is of good standing in the
profession, is of good moral character. I hereby endorse this Candidate to become a Certified AOD Counselor.

_________________________________             ___________________________________ _________________
Colleague Name (Print)                        Colleague Signature                                      Date
________________________________________________________________________________________________
Business Address
________________________________________________________________________________________________
Please print the name of the agency or certification organization that you are registered, certified or licensed by.
Please attach a copy of your credential.
License/Certification Number: ___________________________ Status: Active  Suspended  Retired  Revoked 
Effective Date: _______________________________________ Expiration Date: _________________________
I verify that this Candidate has received ____________ hours of face-to-face supervision from ___________ to ____________ in
the following capacity: _______________________________________________________________
_________________________________________________ _____________________________________________
Candidates Position                                                      Name of Agency/Institution
If you do not meet the criteria, please return this form to the candidate so that he/she may ask someone else for endorsement.
After you complete this form, please return it to the Candidate.

  All questions on the application package must be acknowledged either by a response or N/A where applicable.


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                Counselor Certification Application for: California Certification Board of Chemical Dependency Counselors (CCBCDC)
                   Mailing Address: P.O Box 40043 Downey, CA 90239               Telephone. (562) 927-5143 Fax: 562-392-4682


                                                COLLEAGUE ENDORSEMENT FORM 2



Candidate Name: _____________________________________________Candidate Position: ___________________________

Facility Name: ______________________________________________________ Phone Number: _______________________

Colleague Name: _________________________________ Colleagues Position: _______________________________________

Colleague endorsers must be employed within the AOD field and have first hand knowledge of Candidates work performance.

During the time period from _______________________________ to _______________________________________.
Please comment on:

5. Candidate’s knowledge of the substance abuse treatment process.
________________________________________________________________________________________________________
________________________________________________________________________________________________________
6. Candidate’s ability to work independently.
________________________________________________________________________________________________________
________________________________________________________________________________________________________
7. Candidate’s suitability for private practice.
________________________________________________________________________________________________________
________________________________________________________________________________________________________
8. Would you recommend that this Candidate be licensed as a Chemical Dependency Counse
explain:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
If you do not meet this criterion, please return this form to the candidate so that she/he may ask someone else for this
endorsement.
To the California Certification Board of Chemical Dependency Counselors (CCBCDC):

I hereby state that I have been professionally acquainted with the above named Candidate for _________ years _________
months and am not related to this candidate. To the best of my knowledge and belief, this Candidate is of good standing in the
profession, is of good moral character. I hereby endorse this Candidate to become a Certified AOD Counselor.
_________________________________             ___________________________________ _________________
Colleague Name (Print)                        Colleague Signature                                      Date
________________________________________________________________________________________________
Business Address
________________________________________________________________________________________________
Please print the name of the agency or certification organization that you are registered, certified or licensed by.
Please attach a copy of your credential.
License/Certification Number: ___________________________ Status: Active  Suspended  Retired  Revoked 
Effective Date: _______________________________________ Expiration Date: _________________________
I verify that this Candidate has received ____________ hours of face-to-face supervision from ___________ to ____________ in
the following capacity: _______________________________________________________________
_________________________________________________ _____________________________________________
Candidates Position                                                      Name of Agency/Institution

If you do not meet the criteria, please return this form to the candidate so that he/she may ask someone else for endorsement.
After you complete this form, please return it to the Candidate.

  All questions on the application package must be acknowledged either by a response or N/A where applicable.



                                                                                                                                     9
                 Counselor Certification Application for: California Certification Board of Chemical Dependency Counselors (CCBCDC)
                    Mailing Address: P.O Box 40043 Downey, CA 90239               Telephone. (562) 927-5143 Fax: 562-392-4682



                                                 SUPERVISOR EVALUATION FORM




                                 Supervisor Evaluation Form Page __________ of _____________

Candidates Name: _________________________________________________________________________________
Evaluators Name: _________________________________________________________________________________
Phone Number: _________________________________ Fax Number: ______________________________________
Evaluators Position: _______________________________________________________________________________

I hereby certify that I have observed and have first hand knowledge of the Candidate’s work at:
Facility: ________________________________________________________________________________________
From ___________________________________________________ To _____________________________________

Please note all Supervisors must be in compliance with the California AOD Counselor regulations in
accordance to the California Code of Regulations Chapter 8, Subchapter 3, Section 13040.
Certification Agency: _______________________________________________________________________________

Address: _________________________________________________________________________________________

Certification Number: ____________________________________ Status: Active  Suspended  Retired  Revoked 

Certification Date: _______________________________________ Renewal Date: ____________________________________


    Please comment on:
1. Candidate’s knowledge of the substance abuse treatment process.
________________________________________________________________________________________________________
________________________________________________________________________________________________________

2. Candidate’s ability to work independently.
________________________________________________________________________________________________________
________________________________________________________________________________________________________

3. Candidate’s suitability for private practice.
________________________________________________________________________________________________________
________________________________________________________________________________________________________

4. Would you recommend that this Candidate be licensed as a Chemical Dependency Counselor?                               If No, Please
         explain:
________________________________________________________________________________________________________
________________________________________________________________________________________________________

_____________________________________________________                                   ____________
Supervisor Signature                                                                    Date
Alternate supervisors may be approved on a case-by-case basis. If seeking approval for an alternate supervisor, Candidates
should request, in writing, a special review of their supervisor’s evaluation. The supervisor must be included.
  All questions on the application package must be acknowledged either by a response or N/A where applicable.
                                                                                                                                         10
                Counselor Certification Application for: California Certification Board of Chemical Dependency Counselors (CCBCDC)
                   Mailing Address: P.O Box 40043 Downey, CA 90239               Telephone. (562) 927-5143 Fax: 562-392-4682


                                             SUPERVISOR ENDORSEMENT


Candidate Name: _________________________________ Social Security Number: __________________

Please note all Supervisors must be in compliance with the California AOD Counselor regulations in accordance to the
California Code of Regulations Chapter 8, Subchapter 3, Section 13040.
It is not necessary for the counseling supervisor to be your direct-report, chain-of-command supervisor. The counseling
supervisor must be the professional with whom the Candidate meets for the purpose of discussing clients and counseling issues.
Supervisor must have supervised the Candidate on-site for a minimum of 160 hours and hold an active license or certification.
Supervisor must be licensed or certified pursuant to the California Code of Regulations Chapter 8, Subchapter 3,
Section 13040. As used in this regulation, “supervised” means that the individual providing the training shall:
a) Be physically present and available on site or at an immediately adjacent site, but not necessarily in the same room at all
    times, and
b) Document in the registrants record that the registrant has completed the supervised training required by this subsection.

AOD Counselor Code or Regulations, Section 13005
“Counseling services” means any of the following activities:
(A) Evaluating participants’, patients’, or residents’ AOD treatment or recovery needs, including screening prior to admission,
    intake, and assessment of need for services at the time of admission;
(B) Developing and updating of a treatment or recovery plan;
(C) Implementing the treatment or recovery plan;
(D) Continuing assessment and treatment planning;
(E) Conducting individual counseling sessions, group counseling sessions, face-to-face interviews, or counseling for families,
    couples, and other individuals significant in the life of the participants, patients, or residents; and
(F) Documenting counseling activities, assessment, treatment and recovery planning, clinical reports related to treatment
    provided, progress notes, discharge summaries, and all other client related data.

To the California Certification Board of Chemical Dependency Counselors (CCBCDC):
I hereby state that I have been professionally acquainted with the above named candidate for _________ years _________
months and am not related to this candidate. To the best of my knowledge and belief, this Candidate is of good standing in the
profession, is of good moral character, and has demonstrated effective counseling skills while under my supervision. I hereby
endorse this Candidate to become a Certified AOD Counselor.
_________________________________             ___________________________________                     _________________
Supervisor Name (Print)                       Signature of Supervisor                                 Date
________________________________________________________________________________________________
Business Address
________________________________________________________________________________________________
Please print the name of the agency or certification organization that you are certified or licensed by.
________________________________________________________________________________________________
Please print type of credential you currently hold. (Please attach a copy)
License/Certification Number: ___________________________ Status: Active  Suspended  Retired  Revoked 
Effective Date: _______________________________________ Expiration Date: _________________________
I verify that this Candidate has received ____________ hours of face-to-face supervision from ___________ to ____________ in
the following capacity: _______________________________________________________________

_________________________________________________ _____________________________________________
Candidates Position                                                        Name of Agency/Institution
If you do not meet the criteria, please return this form to the candidate so that he/she may ask someone else for endorsement.
After you complete this form, please return it to the Candidate.

Alternate supervisors may be approved on a case-by-case basis. If seeking approval for an alternate supervisor, Candidates
should request, in writing, a special review of their supervisor’s evaluation. The supervisor must be included.
  All questions on the application package must be acknowledged either by a response or N/A where applicable.



                                                                                                                                     11
                  Counselor Certification Application for: California Certification Board of Chemical Dependency Counselors (CCBCDC)
                     Mailing Address: P.O Box 40043 Downey, CA 90239               Telephone. (562) 927-5143 Fax: 562-392-4682




                                              SUPERVISED EXPERIENCE SUMMARY




Candidate Name:                                                           Social Security Number:

Supervised Experience Summary includes activities designed to provide training in specific counselor function. These activities
are monitored by supervisory personnel who provide timely positive and negative feedback to assist the Counselor in this learning
process. If you received no formal training, your past work experience may be acceptable. In this case, please thoroughly
document such experience explaining how you learned to be a Counselor.

Please see page 14 for a description of domains.
Types of Training/Work Experience: On-The- Job Training (OJT)          In-Service Training Program (TP) Past Work Experience (PWE)
Please list any other Functions on Columns
Functions                          No.    Agency                              Type Of Training           Person Providing Training
                                   Of
                                   Hrs
1. Screening
2. Assessment
3. Treatment Planning
4. Counseling
5. Case Studies
6. Client, Family, and
Community Education

Training Hours __________ Experience Hours ____________Total Training and Experience Hours:______________

Hours must be in compliance with the State of California Alcohol and Drug Programs Administration:
Subchapter 3. Requirements for Certification of AOD Counselors.
§ 13040 (c). Requirements for Initial Certification of AOD Counselors.

2,080 or more documented hours of paid or unpaid work experience providing counseling services in an
AOD program prior to, after, or at the same time as completion of the education required in (a) of this
regulation and the supervised AOD training required in section § 13040 (b) of Subchapter 3, Requirements
for California Alcohol and Drug Programs Administration.

All questions on the application package must be acknowledged either by a response or N/A where
applicable.




                                                                                                                                       12
                Counselor Certification Application for: California Certification Board of Chemical Dependency Counselors (CCBCDC)
                   Mailing Address: P.O Box 40043 Downey, CA 90239               Telephone. (562) 927-5143 Fax: 562-392-4682

                                                      ETHICS & ATTESTATION




1. Are you currently a member of a Professional Association or posses Professional Credentials? Yes              No 
   If “yes” please list all professional and occupational licenses, registrations, or other credentials that you hold. Include state,
   agency/board, number, effective date and expiration date.
   _____________________________________________________________________________________________________

2. Has a professional license or certification held by you ever been revoked, suspended, or voluntarily relinquished? Yes  No

   _____________________________________________________________________________________________________

3. Has a professional credentialing body ever rejected your application because of ethical or legal considerations? Yes  No

   _____________________________________________________________________________________________________

4. Have you ever been convicted or are you now under charges for any lawsuits, court rulings, statement agreements, or
   judgments? Yes       No 
   _____________________________________________________________________________________________________

5. Have you ever lived outside of the State of California? Yes  No 
   If “yes” please list all states in which you have resided.
  _____________________________________________________________________________________________________

6. Have you ever used any other name other than the one provided in this application? Yes  No 
   If “yes” please list all other names used in the past.
  _____________________________________________________________________________________________________

7. Have you ever been the subject of an investigation by a government agency or other entity? Yes  No 
   If “yes” please list all states in which you have resided.
   _____________________________________________________________________________________________________

Please mark the appropriate box for all questions. If you marked “yes” to any of the above questions please provide a full
explanation. Use additional paper if necessary.

Explanation

________________________________________________________________________________________________________
________________________________________________________________________________________________________
We declare under penalty of perjury under the laws of the State of California that the statements above are true and correct.

_____________________________________________________________________
PPRINT NAME


_____________________________________________________________________
SIGNATURE                                                        DATE




                                                                                                                                        13
               Counselor Certification Application for: California Certification Board of Chemical Dependency Counselors (CCBCDC)
                  Mailing Address: P.O Box 40043 Downey, CA 90239               Telephone. (562) 927-5143 Fax: 562-392-4682



                                  CERTIFICATION OF ACCURACY,
                            AGREEMENT AND RELEASE OF AUTHORIZATION



1. By signing this document, I hereby certify that the information provided in this application is true, accurate and
   compete to the best of my knowledge and belief. I understand and agree that the CCBCDC has the right to contact
   any person, government agency, or organization to review or confirm any information provided in this application. I
   further agree to authorize the release of any information requested by the CCBCDC with respect to the review of
   this application. I further understand and agree that the CCBCD has the right to notify pertinent credentialing and
   professional organizations if it is determined that this application contains false information.

2. I understand that if I am granted certification/registration by the CCBCDC and practice counseling, I do so at my
   own risk. I hereby release the CCBCDC from any and all liability and claims that may arise from any and all
   counseling activity in private practice and otherwise.

3. I understand and agree that the CCBCDC registration, certification and re-certification depend upon my fulfillment
   of all required criteria and obligations including compliance with the CCBCDC Code of Ethics. I further agree to
   fully inform the CCBCDC, in a timely manner, if I become the subject of any ethics, disciplinary, criminal, or lesser
   offenses, complaints or charges.

4. I hereby consent to C.C.B.C.D.C. inspection of all record and documents that may be material to an evaluation for
   the certification requested.

5. Upon Registration, Certification or Re-Certification, I understand and agree that the professional biographical data
   is considered to be public information and will be made available in response to consumer/client inquiries. I further
   agree that, for research and statistical purposes only, data resulting from my participation in the CCBCDC
   credentialing process may be used in an anonymous/unidentifiable manner. I understand that all material becomes
   the property of the CCBCDC upon receipt and that neither the originals not photocopies will be returned to me.

6. In the event that my credentials are suspended or revoked, I agree to comply with all directives or orders of the
   CCBCDC, including the return of all CCBCDC credentialing documents. I agree to comply with such directives
   and orders in a timely manner and at my own expense.



_____________________________________________________________________
PRINTED NAME OF CANDIDATE


_____________________________________________________________________
SIGNATURE                                                  DATE

                                     (Duplicate this page before completing)


  All questions on the application package must be acknowledged either by a response or N/A where applicable.




                                                                                                                                    14
                 Counselor Certification Application for: California Certification Board of Chemical Dependency Counselors (CCBCDC)
                    Mailing Address: P.O Box 40043 Downey, CA 90239               Telephone. (562) 927-5143 Fax: 562-392-4682




                                                          APPLICATION FEES

New Application: ________                        Renewal Application: _______

Last Name:                                                           First Name:
D.O.B:                                                                         S.S.#:
Address:
City:                                                                State:                        Zip:
Day Phone:                                                           Evening Phone:


Type of Application: (Please check one)

Certification Application Fee $240.00 _________ (for two years)
Individuals whose have completed all .Certification Application in accordance to Section: § 13040. Requirements for Initial
Certification of AOD Counselors or Section: § 13025. Requirements for Certification by Testing.Of the State Of California
Alcohol and Drug Programs Administration.

Certification Application Fee: $150.00 _________
Examination fees are applicable to all candidates who are eligible to sit for the examination after completing all requirements of
the Certification Application.

                                    All fees are non-refundable and non-transferable.
          If you would like to make a payment plan please contact our office to receive payment plan application.
          A $25.00 fee will be charged to all returned checks *



                                  The followoing Amount $________________

    Credit Card Number: ________________________
    Expiration Date: _____________ CV Code: ______
    Name on Credit Card: ____________________________
    Address: ______________________________________


Payments must be mailed to:

            CALIFORNIA CERTIFICATION BOARD OF CHEMICAL DEPENDENCY COUNSELORS (CCBCDC)
                                                        Mailing Address
                                                         P.O Box 40043
                                                       Downey, CA 90239
                                                    Telephone. (562) 927-5143



    Candidate Signature                                                                 Date

  All questions on the application package must be acknowledged either by a response or N/A where applicable.


                                                                                                                                      15
                Counselor Certification Application for: California Certification Board of Chemical Dependency Counselors (CCBCDC)
                   Mailing Address: P.O Box 40043 Downey, CA 90239               Telephone. (562) 927-5143 Fax: 562-392-4682


      ACKNOWLEDGEMENT OF COUNSELOR CODE OF ETHICS AND COUNSELOR CODE OF CONDUCT




The California Certification Board of Chemical Dependency Counselors (CCBCDC) is the Certifying Organization /Board. The
CCBCDC provides voluntary certification for Chemical Dependency Counselors in the State of California as a way of assuring
professional competence to clients, to the public, and to employers. The CCBCDC is dedicated to the principle that counselors in
the field of alcohol and drug treatment must confront their behavior to the highest standards of ethical practice. To that end, the
CCBCDC has adopted this Counselor Code of Ethics in combination with the Counselor Code of Conduct to be applied to all pre-
certified and Certified Counselors in the state of California.

ACKNOWLEDGEMENT
I agree to follow the CCBCDC Counselor Code of Ethics and Counselor Code of Conduct.

I have read the Counselor Code of Ethics and Counselor Code of Conduct and fully understand all that is contained in it. A copy
has been provided to me with the Counselor Certification/Registration application.

I further agree to follow all policies and procedures contained in the Counselor Code of Ethics and Counselor Code of Conduct..
I understand my rights and my responsibilities as an Alcohol and other Drug Counselor.




Counselor Signature                                                 Date




________________________________________________________                               ___________________________
Print Full Name                                                                        CCBCDC Credential Number



  All questions on the application package must be acknowledged either by a response or N/A where
  applicable.

Please include this original signed form with your application package
Note: Keep a copy of this form for your records.




                                                                                                                                      16
               Counselor Certification Application for: California Certification Board of Chemical Dependency Counselors (CCBCDC)
                  Mailing Address: P.O Box 40043 Downey, CA 90239               Telephone. (562) 927-5143 Fax: 562-392-4682




CCBCDC CODE OF ETHICS

_____________________________________________________________________
PROFESSIONAL STANDARDS
  1.    A counselor shall not fail to meet and comply with all terms, conditions, or limitations of a certification or registration.
  2.    Certified Counselors and Registered interns shall maintain a current mailing address and contact telephone number in accordance to
        California Certification Board of Chemical Dependency Counselors guidelines.
  3.    A counselor shall not engage in conduct, which does not meet the generally accepted standards of practice of This Chapter of Chapter
        8 (commencing with Section 13000), and Amendment of Sections 9846, 10125, and 10564, Division 4, Title 9, California Code of
        Regulations.
  4.    Registered Interns and Certified Counselors must comply with the Education rules and regulations of this sections 13015, 13020,
        13025, 13030, and 13040.
  5.    Advertisements and Directories must be in compliance with: the California Certification Board of Chemical Dependency Counselors
        rules and regulations of this chapter.
  6.    A counselor shall not perform services outside of the counselor's area of training, expertise, competence, or scope of practice. In
        accordance to this chapter.
  7.    A counselor shall not fail to obtain an appropriate consultation or make an appropriate referral when the client's problem is beyond the
        counselor's area of training, expertise, competence, or scope of practice.
  8.    Education: Certified or Registered AOD Counselors must comply with but not limited to the education and continuing education
        rules and regulations of this chapter as set forth by the California Certification Board of Chemical Dependency Counselors.
  9.    A Certified Counselor or Registered Intern shall not in any way participate in discrimination on the basis of race, color, sex, sexual
        orientation, age, religion, national origin, socio-economic status, political belief, psychiatric or psychological impairment, physical
        disability, or the amount of previous therapeutic or treatment occurrences.
  10.   A counselor shall not refuse to seek therapy for any psychoactive substance abuse or dependence, psychiatric or psychological
        impairment, emotional distress, or for any other physical health related adversity that interferes with the counselor's professional
        functioning, and where any such conditions exist and impede the counselor's ability to function competently, a counselor shall request
        inactive status for medical reasons for so long as is necessary. In accordance to section 4022 of this chapter.
  11.   The counselor shall not discontinue professional services to a client/patient nor shall the counselor abandon the client/patient without
        facilitating an appropriate therapeutic closure of professional services for the client/patient. The counselor shall not discontinue
        professional services to a client/patient unless: Services have been completed; The client/patient requests the discontinuation;
        Alternative or replacement services are arranged; or The client/patient is given reasonable opportunity to arrange alternative or
        replacement services.
  12.   A counselor shall not reveal confidential information obtained as the result of a professional relationship, without the prior written
        consent from the recipient of services, except as authorized or required by law.
  13.   Certified Counselors who are convicted of any felony shall have their certification revoked.\
  14.   Counselors charged with a misdemeanor relating to the counselor's ability to practice the substance abuse counseling profession shall
        be grounds for disciplinary action.
  15.   A certificate or conviction shall be deemed conclusive evidence of a counselor's guilt of the felony or misdemeanor for which he or
        she has been convicted.
  16.   A counselor shall not engage in any form of sexual contact/behavior with clients, nor engage in any form of sexual contact/behavior
        with former therapy clients for two years after the cessation or termination of professional services within the client's continuum of
        care. The prohibition shall apply with respect to any client/patient of the agency by which the counselor is employed, regardless of
        whether or not the client/patient is on the counselor's caseload.
  17.   A counselor shall not: Present or cause to be presented a false or fraudulent claim, or any proof in support of such claim, to be paid
        under any contract or certificate of insurance;
  18.   Prepare, make or subscribe to a false or fraudulent account, certificate, affidavit, proof of loss or other document or writing, with
        knowledge that the same may be presented or used in support of a claim for payment under a policy of insurance; or
  19.   Present or cause to be presented a false or fraudulent claim or benefit application, or any false or fraudulent proof in support of such a
        claim or benefit application, or false or fraudulent information, which would affect a future claim or benefit application, to be paid
        under any employee benefit program.
  20.   A counselor shall not use misrepresentation in the preparation of a counselor certification development plan or in the procurement of
        certification or recertification as an alcohol or drug counselor, or assist another in the preparation of a certification development plan
        or in the procurement of registration, certification or re-certification through misrepresentation. The term "misrepresentation" includes
        but is not limited to the misrepresentation of professional qualifications, certification, accreditation, affiliations, employment
        experience, the plagiarism of application and recertification materials, or the falsification of references.
  21.   A counselor shall not use a title designation, credential or license, firm name, letterhead, publication, term, title, or document, which
        states or implies an ability, relationship, or qualification that does not exist.
  22.   A counselor shall not practice under a false name or under a name other than the name under which his or her certification or license is
        held.
  23.   A counselor shall not sign or issue in the counselor's professional capacity a document or a statement that the counselor knows or
        should have known to contain a false or misleading statement.
  24.   A counselor shall not produce, publish, create, or partake in the creation of any false, fraudulent, deceptive, or misleading
        advertisement.
  25.   A counselor shall not misappropriate property from a client/patient.
  26.   A counselor shall not enter into a relationship with a client/patient, which involves financial gain to the counselor or a third party
        resulting from the promotion or the sale of services, unrelated to treatment or of goods, property, or any psychoactive substance.
                                                                                                                                                     17
             Counselor Certification Application for: California Certification Board of Chemical Dependency Counselors (CCBCDC)
                Mailing Address: P.O Box 40043 Downey, CA 90239               Telephone. (562) 927-5143 Fax: 562-392-4682
27. A counselor shall not promote to a client/patient for the counselor's personal gain any unnecessary, ineffective or unsafe psychoactive
    substance, or any unnecessary, ineffective or unsafe device, treatment, procedure, product or service.
28. A counselor shall not solicit gifts or favors from clients.
29. In circumstances where the counselor becomes aware, during the course of providing or supervising professional services, that a
    condition of clear and imminent danger exists that a client/patient may inflict serious bodily harm on another person or persons, the
    counselor shall, consistent with federal and state regulations concerning the confidentiality of alcohol and drug counseling records,
    take reasonable steps to warn any likely victims of the client's behavior.
30. In circumstances where the counselor becomes aware, during the course of providing or supervising professional services, that a
    condition of clear and imminent danger exists that a client/patient may inflict serious bodily harm to himself or herself, the counselor
    shall, consistent with federal and state regulations concerning the confidentiality of alcohol and drug counseling records, take
    reasonable steps to protect that client/patient.
31. A counselor shall not administer to himself or herself any psychoactive substance to the extent or in such manner as to be dangerous
    or injurious to a recipient of services, to any other person, or to the extent that such use of any psychoactive substance impairs the
    ability of the counselor to safely and competently provide professional counseling services.
32. A counselor shall not falsify, amend, knowingly make incorrect entries, or fail to make timely essential entries into the client/patient
    record.
33. A counselor shall follow all Federal and State regulations regarding client/patient records.
34. A counselor shall not refer a client/patient to a person that the counselor knows or should know is not qualified by training,
    experience, certification, or license to perform the delegated professional responsibility.
35. A counselor shall not practice substance abuse counseling during the period of any denial, suspension, revocation, probation, or other
    restriction or discipline on certification, license, or other authorization to practice issued by any certification authority or any state,
    province, territory, tribe, or the federal government.
36. A counselor shall cooperate in any investigation conducted pursuant to this Code of Conduct and a counselor shall not interfere with
    an investigation or a disciplinary proceeding or attempt to prevent a disciplinary proceeding or other legal action from being filed,
    prosecuted, or completed. Interference attempts may include but are not limited to: The willful misrepresentation of facts before the
    disciplining authority or its authorized representative;
          a) The use of threats or harassment against, or an inducement to, any client/patient or witness in an effort to prevent them from
                providing evidence in a disciplinary proceeding or any other legal action;
          b) The use of threats or harassment against, or an inducement to, any person in an effort to prevent or attempt to prevent a
                disciplinary proceeding or other legal action from being filed, prosecuted or completed.
37. A counselor shall report any violation of the Counselor Code of Conduct. Failure to report a violation may be grounds for discipline.
38. A counselor who has firsthand knowledge of the actions of a respondent counselor or a complainant shall cooperate with a the
    California Certification Board of Chemical Dependency Counselors complaint investigation or disciplinary proceeding. Failure or an
    unwillingness to cooperate with the California Certification Board of Chemical Dependency Counselors complaint investigation or
    disciplinary proceeding shall be grounds for disciplinary action.
39. A counselor shall not file a complaint or provide information to the California Certification Board of Chemical Dependency
    Counselors, which the counselor knows or should have known, is false or misleading.
40. In submitting any information to the Certification Organization, a counselor shall comply with any requirements pertaining to the
    disclosure of client/patient information established by the federal or state government.
41. Violent And Serious Felonies Pursuant To Penal Codes 667.5(C) And 1192.7(C).
          Enhancement of prison terms for new offenses because of prior prison terms shall be imposed as follows:
            (a) Where one of the new offenses is one of the violent felonies specified in subdivision (c), in addition to and consecutive to
          any other prison terms therefore, the court shall impose a three-year term for each prior separate prison term served by the
          defendant where the prior offense was one of the violent felonies specified in subdivision (c). However, no additional term shall
          be imposed under this subdivision for any prison term served prior to a period of 10 years in which the defendant remained free
          of both prison custody and the commission of an offense which results in a felony conviction.
            (b) Except where subdivision (a) applies, where the new offense is any felony for which a prison sentence is imposed, in
          addition and consecutive to any other prison terms therefore, the court shall impose a one-year term for each prior separate prison
          term served for any felony; provided that no additional term shall be imposed under this subdivision for any prison term served
          prior to a period of five years in which the defendant remained free of both prison custody and the commission of an offense
          which results in a felony conviction.
            (c) For the purpose of this section, "violent felony" shall mean any of the following:
            (1) Murder or voluntary manslaughter.
            (2) Mayhem.
            (3) Rape as defined in paragraph (2) or (6) of subdivision (a) of Section 261 or paragraph (1) or (4) of subdivision (a) of
          Section 262.
            (4) Sodomy by force, violence, duress, menace, or fear of
          immediate and unlawful bodily injury on the victim or another person.
            (5) Oral copulation by force, violence, duress, menace, or fear of immediate and unlawful bodily injury on the victim or another
          person.
            (6) Lewd acts on a child under the age of 14 years as defined in Section 288.
            (7) Any felony punishable by death or imprisonment in the state prison for life.
            (8) Any felony in which the defendant inflicts great bodily injury on any person other than an accomplice which has been
          charged and proved as provided for in Section 12022.7 or 12022.9 on or after July 1, 1977, or as specified prior to July 1, 1977,
          in Sections 213, 264, and 461, or any felony in which the defendant uses a firearm which use has been charged and proved as
          provided in Section 12022.5 or 12022.55.
            (9) Any robbery.
            (10) Arson, in violation of subdivision (a) or (b) of Section 451.
            (11) The offense defined in subdivision (a) of Section 289 where the act is accomplished against the victim's will by force,
          violence, duress, menace, or fear of immediate and unlawful bodily injury on the victim or another person.
            (12) Attempted murder.
                                                                                                                                                  18
  Counselor Certification Application for: California Certification Board of Chemical Dependency Counselors (CCBCDC)
     Mailing Address: P.O Box 40043 Downey, CA 90239               Telephone. (562) 927-5143 Fax: 562-392-4682
  (13) A violation of Section 12308, 12309, or 12310.
  (14) Kidnapping.
  (15) Assault with the intent to commit mayhem, rape, sodomy, or oral copulation, in violation of Section 220.
  (16) Continuous sexual abuse of a child, in violation of Section 288.5.
  (17) Carjacking, as defined in subdivision (a) of Section 215.
  (18) A violation of Section 264.1.
  (19) Extortion, as defined in Section 518, which would constitute a felony violation of Section 186.22 of the Penal Code.
  (20) Threats to victims or witnesses, as defined in Section 136.1, which would constitute a felony violation of Section 186.22 of
the Penal Code.
  (21) Any burglary of the first degree, as defined in subdivision (a) of Section 460, wherein it is charged and proved that another
person, other than an accomplice, was present in the residence during the commission of the burglary.
  (22) Any violation of Section 12022.53.
  (23) A violation of subdivision (b) or (c) of Section 11418.
  The Legislature finds and declares that these specified crimes merit special consideration when imposing a sentence to display
society's condemnation for these extraordinary crimes of violence against the person.

  (d) For the purposes of this section, the defendant shall be deemed to remain in prison custody for an offense until the official
discharge from custody or until release on parole, whichever first occurs, including any time during which the defendant remains
subject to re-imprisonment for escape from custody or is re-imprisoned on revocation of parole. The additional penalties
provided for prior prison terms shall not be imposed unless they are charged and admitted or found true in the action for the new
offense.
(e) The additional penalties provided for prior prison terms shall not be imposed for any felony for which the defendant did not
serve a prior separate term in state prison.
(f) A prior conviction of a felony shall include a conviction in another jurisdiction for an offense which, if committed in
California, is punishable by imprisonment in the state prison if the defendant served one year or more in prison for the offense in
the other jurisdiction. A prior conviction of a particular felony shall include a conviction in another jurisdiction for an offense
which includes all of the elements of the particular felony as defined under California law if the defendant served one year or
more in prison for the offense in the other jurisdiction.
(g) A prior separate prison term for the purposes of this section shall mean a continuous completed period of prison incarceration
imposed for the particular offense alone or in combination with concurrent or consecutive sentences for other crimes, including
any re-imprisonment on revocation of parole which is not accompanied by a new commitment to prison, and including any re-
imprisonment after an escape from incarceration.
  (h) Serving a prison term includes any confinement time in any state prison or federal penal institution as punishment for
commission of an offense, including confinement in a hospital or other institution or facility credited as service of prison time in
the jurisdiction of the confinement.
  (i) For the purposes of this section, a commitment to the State Department of Mental Health as a mentally disordered sex
offender following a conviction of a felony, which commitment exceeds one year in duration, shall be deemed a prior prison
term.
  (j) For the purposes of this section, when a person subject to the custody, control, and discipline of the Director of Corrections
is incarcerated at a facility operated by the Department of the Youth Authority, that incarceration shall be deemed to be a term
served in state prison.
  (k) Notwithstanding subdivisions (d) and (g) or any other provision of law, where one of the new offenses is committed while
the defendant is temporarily removed from prison pursuant to Section 2690 or while the defendant is transferred to a community
facility pursuant to Section 3416, 6253, or 6263, or while the defendant is on furlough pursuant to Section 6254, the defendant
shall be subject to the full enhancements provided for in this section.
  This subdivision shall not apply when a full, separate, and consecutive term is imposed pursuant to any other provision of law.
1192.7. (a) Plea bargaining in any case in which the indictment or information charges any serious felony, any felony in which it
is alleged that a firearm was personally used by the defendant, or any offense of driving while under the influence of alcohol,
drugs, narcotics, or any other intoxicating substance, or any combination thereof, is prohibited, unless there is insufficient
evidence to prove the people's case, or testimony of a material witness cannot be substantial change in sentence.
  (b) As used in this section "plea bargaining" means any bargaining, negotiation, or discussion between a criminal defendant, or
his or her counsel, and a prosecuting attorney or judge, whereby the defendant agrees to plead guilty or nolo contendere, in
exchange for any promises, commitments, concessions, assurances, or consideration by the prosecuting attorney or judge relating
to any charge against the defendant or to the sentencing of the defendant.
  (c) As used in this section, "serious felony" means any of the following:
  (1) Murder or voluntary manslaughter; (2) mayhem; (3) rape; (4) sodomy by force, violence, duress, menace, threat of great
bodily injury, or fear of immediate and unlawful bodily injury on the victim or another person; (5) oral copulation by force,
violence, duress, menace, threat of great bodily injury, or fear of immediate and unlawful bodily injury on the victim or another
person; (6) lewd or lascivious act on a child under the age of 14 years; (7) any felony punishable by death or imprisonment in the
state prison for life; (8) any felony in which the defendant personally inflicts great bodily injury on any person, other than an
accomplice, or any felony in which the defendant personally uses a firearm; (9) attempted murder; (10) assault with intent to
commit rape or robbery; (11) assault with a deadly weapon or instrument on a peace officer; (12) assault by a life prisoner on a
non-inmate; (13) assault with a deadly weapon by an inmate; (14) arson; (15) exploding a destructive device or any explosive
with intent to injure; (16) exploding a destructive device or any explosive causing bodily injury, great bodily injury, or mayhem;
(17) exploding a destructive device or any explosive with intent to murder; (18) any burglary of the first degree; (19) robbery or
bank robbery; (20) kidnapping; (21) holding of a hostage by a person confined in a state prison; (22) attempt to commit a felony
punishable by death or imprisonment in the state prison for life; (23) any felony in which the defendant personally used a
dangerous or deadly weapon; (24) selling, furnishing, administering, giving, or offering to sell, furnish, administer, or give to a
minor any heroin, cocaine, phencyclidine (PCP), or any methamphetamine-related drug, as described in paragraph (2) of
subdivision (d) of Section 11055 of the Health and Safety Code, or any of the precursors of methamphetamines, as described in
subparagraph (A) of paragraph (1) of subdivision (f) of Section 11055 or subdivision (a) of Section 11100 of the Health and
                                                                                                                                       19
                 Counselor Certification Application for: California Certification Board of Chemical Dependency Counselors (CCBCDC)
                    Mailing Address: P.O Box 40043 Downey, CA 90239               Telephone. (562) 927-5143 Fax: 562-392-4682
              Safety Code; (25) any violation of subdivision (a) of Section 289 where the act is accomplished against the victim's will by force,
              violence, duress, menace, or fear of immediate and unlawful bodily injury on the victim or another person; (26) grand theft
              involving a firearm; (27) carjacking; (28) any felony offense, which would also constitute a felony violation of Section 186.22;
              (29) assault with the intent to commit mayhem, rape, sodomy, or oral copulation, in violation of Section 220; (30) throwing acid
              or flammable substances, in violation of Section 244; (31) assault with a deadly weapon, firearm, machinegun, assault weapon, or
              semiautomatic firearm or assault on a peace officer or firefighter, in violation of Section 245; (32) assault with a deadly weapon
              against a public transit employee, custodial officer, or school employee, in violation of Sections 245.2, 245.3, or 245.5; (33)
              discharge of a firearm at an inhabited dwelling, vehicle, or aircraft, in violation of Section 246; (34) commission of rape or sexual
              penetration in concert with another person, in violation of Section 264.1; (35) continuous sexual abuse of a child, in violation of
              Section 288.5; (36) shooting from a vehicle, in violation of subdivision (c) or (d) of Section 12034; (37) intimidation of victims
              or witnesses, in violation of Section 136.1; (38) criminal threats, in violation of Section 422; (39) any attempt to commit a crime
              listed in this subdivision other than an assault; (40) any violation of Section 12022.53; (41) a violation of subdivision (b) or (c) of
              Section 11418; and (42) any conspiracy to commit an offense described in this subdivision.
                 (d) As used in this section, "bank robbery" means to take or attempt to take, by force or violence, or by intimidation from the
              person or presence of another any property or money or any other thing of value belonging to, or in the care, custody, control,
              management, or possession of, any bank, credit union, or any savings and loan association.
                 As used in this subdivision, the following terms have the following meanings:
                 (1) "Bank" means any member of the Federal Reserve System, and any bank, banking association, trust company, savings bank,
              or other banking institution organized or operating under the laws of the United States, and any bank the deposits of which are
              insured by the Federal Deposit Insurance Corporation.
                 (2) "Savings and loan association" means any federal savings and loan association and any "insured institution" as defined in
              Section 401 of the National Housing Act, as amended, and any federal credit union as defined in Section 2 of the Federal Credit
              Union Act.
                 (3) "Credit union" means any federal credit union and any state-chartered credit union the accounts of which are insured by the
              Administrator of the National Credit Union administration.
              (e) The provisions of this section shall not be amended by the Legislature except by statute passed in each house by rollcall vote
              entered in the journal, two-thirds of the membership concurring, or by a statute that becomes effective only when approved by the
              electors.
         42. Disciplinary sanctions to issued by another state or governmental licensing and certification agency.
         43. A person held in custody, captivity, or a condition of forcible restraint, especially while on trial or serving a prison sentence may
              not apply to the CCBCDC for registration or certification.
         44. Engaging in unprofessional conduct, including but not limited to (a) any practice that creates unnecessary danger to a client's life,
              health or safety; and (b) any practice that is contrary to the ethical conduct in accordance to the CCBCDC Code of Ethics that
              results in termination or suspension from practice.
         45. A Counselors/Registered intern shall not physically, verbally threaten, harass or abuse any patient/client, co-worker,
              administrators, or CCBCDC employees, volunteers, board members, committee members.


         DISCIPLINARY PROCEDURES/CONFIDENTIALITY of PROCEEDINGS
         Except as is otherwise provided herein, all information received and all reports, decisions files, transcripts or any other documents, of
         any kind, generated or received during the course of a disciplinary proceeding shall be kept confidential by the California Certification
         Board of Chemical Dependency Counselors and the respondent.

         * Amended 09/29/2009: Reflect New CCBCDC Address

COMPLAINTS
Persons wishing to file a complaint against a certified counselor or against a person under the California Certification Board of Chemical
Dependency Counselors jurisdiction seeking certification may do so by obtaining and filling out a formal complaint form. Complaint forms may
be obtained from the California Certification Board of Chemical Dependency Counselors office.

All complaint forms must contain the complainant's address and a phone number where the complainant can be contacted. The complainant
must sign and date the complaint form. Mail complaint forms to the following address:




                                                                                                                                                        20
                 Counselor Certification Application for: California Certification Board of Chemical Dependency Counselors (CCBCDC)
                    Mailing Address: P.O Box 40043 Downey, CA 90239               Telephone. (562) 927-5143 Fax: 562-392-4682

              Mailing Address:      P.O Box 40043 Downey, CA 90239           Telephone. (562) 927-5143




California Certified AOD Counselors – Uniform Code of Conduct
Final version June 29, 2009 – Effective date September 1, 2009

This Code of Conduct shall prohibit registrants and certified alcohol and other drug (AOD) counselors from:

1. Securing a certification or registration by fraud, deceit, or misrepresentation on any application submitted to the
certifying organization whether engaged in by an applicant for certification or registration or in support of any application
for certification or registration.

2. Administering to himself or herself any controlled substance as defined in section 4021 of the Business and Professions
Code, or using any of the dangerous drugs or devices specified in section 4022 of the Business and Professions Code or
using any alcoholic beverage to the extent, or in a manner, as to be dangerous or injurious to the person applying for a
certification or holding a registration or certification, or to any other person, or to the public, or, to the extent that the use
impairs the ability of the person applying for or holding a registration or certification to conduct with safety to the public
the counseling authorized by the registration or certification.

3. Gross negligence or incompetence in the performance of alcohol and other drug counseling.

4. Violating, attempting to violate, or conspiring to violate any regulation adopted by ADP.

5. Misrepresentation as to the type or status of certification or registration held by the person, or otherwise misrepresenting
or permitting misrepresentation of his or her education, professional qualifications, or professional affiliations to any person
or entity, and failure to state proper certification or licensure initials and numbers on business cards, brochures, websites,
etc.

6. Impersonation of another by any counselor or registrant, or applicant for a certification or registration, or, in the case of
a counselor, allowing any other person to use his or her certification or registration.

7. Aiding or abetting any uncertified or unregistered person to engage in conduct for which certification or registration is
required.

8. Providing services beyond the scope of his/he registration or certification as an AOD counselor or his or her professional
license, if the individual is a licensed counselor as defined in Secton13015.

9. Intentionally or recklessly causing physical or emotional harm to any client.

10. The commission of any dishonest, corrupt, or fraudulent act substantially related to the qualifications, functions, or
duties of a counselor or registrant.

11. Engaging in sexual relations with a client or with a former client within two years from the termination date of therapy
with the client, soliciting sexual relations with a client, or committing an act of sexual abuse, or sexual misconduct with a
client, or committing an act punishable as a sexually related crime, if that act or solicitation is substantially related to the
qualifications, functions, or duties of an alcohol and other drug counselor.

12. Engaging in a social or business relationship with clients, program participants, patients, or residents or other persons
significant to them while they are in treatment and exploiting former clients, program participants, patients, or residents.

13. Verbally, physically or sexually harassing, threatening, or abusing any participant, patient, resident, their family
members, other persons who are significant to them, or other staff members.

14. Failure to maintain confidentiality, except as otherwise required or permitted by law, including but not limited to Code
of Federal Regulations, Title 42, Part 2.

15. Advertising that in reasonable probability will cause an ordinarily prudent person to misunderstand or be deceived;
makes a claim either of professional superiority or of performing services in a superior manner, unless that claim is relevant
to the service being performed and can be substantiated with objective scientific evidence; makes a scientific claim that
cannot be substantiated by reliable, peer reviewed, published scientific studies.

16. Failure to keep records consistent with sound professional judgment, the standards of the profession, and the nature of
the services being rendered.

17. Willful denial of access to client records as otherwise provided by law.


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