Follow the steps to complete the form effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In Part One, provide your applicant information, which includes your name, position title, employer, and the type of position (Full-Time, Part-Time, Paid, or Volunteer). Also, include the employment dates in the specified format (MM/DD/YYYY to MM/DD/YYYY).
3. Once you have completed Part One, hand it over to your qualified supervisor for them to fill out Part Two.
4. In Part Two, the qualified supervisor will fill in their contact information, including last name, first name, title, employer, email address, business phone, and work address.
5. The supervisor will need to provide a brief explanation of their qualifications for being a supervisor in the Supervision Attestation section.
6. The supervisor must record the number of hours spent on supervision in each performance domain category: Advocacy, Mentoring, Recovery Support, and Professional Responsibility. Ensure that you document both individual and group supervision hours.
7. The supervisor should indicate the time period during which supervision was provided, including start and end dates.
8. Finally, the qualified supervisor will sign and date the form. They can provide an electronic signature if necessary.
9. After both parts are completed, the form must be submitted to the Florida Certification Board. This can be done through mail, email, or fax, as detailed in the instructions.
10. Once you have saved the changes to the form, you can download, print, or share it as needed.

Start completing your forms online today to advance your certification process.