APPLICANT’S RECOGNITION STATEMENT

The applicant acknowledges that the applicant is seeking certification from the Addiction Professionals Certification Board, Inc. (hereinafter “The Board”). The applicant hereby recognizes and agrees as follows:
Applicant agrees to observe and abide by the Ethical Standards adopted by The Board as same may be amended from time to time.

Applicant acknowledges that the present form of ethical standards attached hereto and that the applicant has read and understood same.

Applicant recognizes and agrees that any certification, or renewal thereof, granted by The Board to the applicant constitutes recognition by The Board that the applicant is qualified, based on the information before The Board, for the certification granted.

Applicant recognizes and agrees that any certification, or renewal granted by The Board, does not constitute a property right or interest of the applicant.

The applicant specifically recognizes and agrees that the certification or renewal is specific to suspension, revocation or other limitation or condition in the discretion of The Board. The applicant specifically recognizes the authority of The Board to suspend, revoke or otherwise impose limitations, restrictions and conditions on any certification granted applicant agrees to cooperate in connection with any investigation conducted by The Board with respect to the applicant’s certification, and continued qualification to hold same.

The applicant further agrees that the applicant’s failure to cooperate with any such investigation;

Shall in itself constitute an ethical violation for which discipline may be imposed and

May be considered by The Board as an admission of wrongdoing.

I understand that I have a right to an appeal from any Ethics Committee decision regarding my status as an APCB certified professional and that I have 180 days from the time of my denial.

The appeal will first be heard by the Board’s Ethics Committee and, if not found in your favor, be appealed to the full Board for an appeal hearing .Appeals must be addressed in writing and sent to the Executive Director at the Board’s office. We suggest that you send appeals via registered mail.