Get Oh Supervisor Reference Form 2013-2025

This guide provides clear instructions on filling out the OH Supervisor Reference Form online. By following these steps, you will successfully document the required hours of work experience as a clinical supervisor for chemical dependency counseling services.

Follow the steps to complete the form accurately.

1. Press the ‘Get Form’ button to obtain the OH Supervisor Reference Form and access it in your preferred online editor.
2. In Part A, begin by entering your name — first, middle, and last — and your Social Security number. This information is crucial for identification purposes.
3. Next, provide your employer's name and address in the designated fields to inform the Board of your clinical work environment.
4. Enter your job title to clarify your position and responsibilities within the organization.
5. Sign the Waiver of Liability section, authorizing your supervisor to share relevant information about your qualifications with the Board. Ensure this is completed before giving the form to your supervisor.
6. Once you have completed Part A, hand the form to your supervisor for their input in Part B.
7. Instruct your supervisor to review Part A and complete Part B only if they have your signed waiver. They will fill in their name, title, professional credentials, and the applicant's name they have supervised.
8. Your supervisor must also record the dates they supervised you, including the total hours and average hours worked per week, ensuring to meet the minimum requirements for certification.
9. Additionally, your supervisor will need to indicate if they are aware of any unethical behavior and whether they recommend you for certification, providing comments if necessary.
10. Finally, your supervisor should sign and date the form to validate the information provided. Ensure the completed form is returned to you.
11. You can now save any changes made, download the form, print it for your records, or share it as needed to complete the submission process.

Take the next step towards your certification by completing the OH Supervisor Reference Form online today.