Application for Court Interpreter Registration Renewal

Court Interpreter Certification

and Regulation Program

Application

for Court Interpreter

Registration Renewal

Page 1 of 10

Court Interpreter Certification

and Regulation Program (CICRP)

Application for Court Interpreter Registration Renewal

Please print or type. The application will be returned, without being processed, if it is in any way incomplete or the

applicable fee and any required documentation are not included.

PURPOSE OF FORM: This form is to be used by interpreters who are registered by the Court Interpreter Certification

Board, a body appointed by the Supreme Court of Florida, to apply for renewal of their registration.

INSTRUCTIONS: Return the completed and notarized form, along with the $200.00 non-refundable, biennial renewal

fee, to: Court Interpreter Certification and Regulation Program ■ Supreme Court Building ■ 500 S. Duval Street ■

Tallahassee, Florida 32399-1900. The fee must be in the form of a cashier’s check or money order, made payable to

the State of Florida. Please type or print clearly. Your contact information will be updated in our records.

I. INTERPRETER INFORMATION

Full Name:

Last Five Digits of Social Security Number:

Address:

City, State, Zip Code:

Other Personal Contact Information:

Home Phone:

Work Phone:

Cell Phone:

Fax Number:

Email Address:

Website:

Do Not Publish

(Check Box)

Interpreter Designation Number (if any):

Language(s) of Registration:

Renewal Date:

FOR OFFICE USE ONLY

Date Received:

Fee Paid:

Cashier’s Check/Money Order Number

Date Entered:

Received By:

IMPORTANT INFORMATION: PLEASE SUBMIT YOUR RENEWAL PACKET CONTAINING THIS APPLICATION, PAYMENT,

CONTINUING INTERPRETER EDUCATION REPORTING FORM, LAW-RELATED PROFESSIONAL INTERPRETING ASSIGNMENTS

REPORTING FORM, INTERPRETER OATH FORM, AND AFFIDAVIT FOR COURT EMPLOYED STAFF INTERPRETERS (IF

APPLICABLE), SIX WEEKS IN ADVANCE OF YOUR RENEWAL DATE TO ALLOW FOR PROCESSING TIME AND CONTINUED

REGISTRATION.

CICRP-FORM-005

Revised: 03/28/2023

Page 2 of 10

II. BACKGROUND AND CRIMINAL OFFENSES

Background Check – Applicants may be subject to a background check (see application instructions). Please

answer each question below.

Answering “yes” to these questions will not necessarily disqualify you from renewal of registration. Each case will

be considered individually.

A. Have

you ever been convicted of, pled guilty, or pled no contest, regardless of

whether adjudication of guilt or imposition of sentence was suspended, deferred, or

withheld in relation to any of the following:

(1) a felony, misdemeanor of the first degree, or a misdemeanor of the second degree

involving dishonesty or false statement;

Yes No

(2) a conv

iction of a similar offense described in subdivision (1) that includes a

conviction by a federal, military, or tribal tribunal, including courts-martial conducted by

the Armed Forces of the United States;

Yes No

(3) a conviction of a similar offense described in subdivision (1) that includes a conviction

or entry of a plea of guilty or no contest resulting in a sanction in any jurisdiction of the

United States or any foreign jurisdiction. A sanction includes, but is not limited to, a fine,

incarceration in a state prison, federal prison, private correctional facility, or local

detention facility;

Yes No

(4) a conviction of a similar offense described in subdivision (1) of a municipal or

county ordinance in this or any other state;

Yes No

B. Have you ever been sanctioned or disciplined for a breach of ethics or unprofessional

conduct by any court, regulatory body, administrative agency, bar association or other

professional group? (Note: If no probable cause was found, there is no need to report.)

Yes No

C. Within the last five years, have you ever been demoted, disciplined, suspended,

terminated, or formally reprimanded by an employer because of immoral conduct,

substance abuse, sexual impropriety, or abusive behavior? If so, please state the

circumstances under which such action was taken, the date(s) such action was taken, the

name(s) of any persons who took such action, the background and resolution of such

action and relevant documentation.

Yes No

D. Have you ever applied for certification or licensure in any state as a member of a

recognized profession and been denied due to fraud, dishonesty, corruption,

unprofessional or unethical conduct?

Yes No

E. Have you ever had a final judgment for protection against domestic violence, sexual

violence, dating violence, repeat violence, risk protection order, or stalking entered

against you?

Yes No

F. Has the incident(s) noted above been previously reported on an initial application for

court interpreter registration/designation or subsequent renewal?

Yes No N/A

If so, please provide the date of the application or renewal. You do not need to provide

any documentation previously submitted. (MM/DD/YYYY)

Page 3 of 10

If you answered “yes” to any of the above background questions, you must provide the following information:

a) Copies of all documentation related to the case and itsresolution.

b) A statement, as to the circumstances surrounding the incident(s).

c) A statement describing and a copy of the order if currently on probation.

d) Any effort at rehabilitation.

e) Any other information you believe would be useful in reviewing yourapplication.

NOTE: If you do not provide all copies of related information, you will be asked to furnish additional documents before

your renewal application will be reviewed.

Page 4 of 10

Court Interpreter Certification

and Regulation Program (CICRP)

APPLICANT WAIVER AGREEMENT AND STATEMENT

For Criminal History Record Checks

This form shall be completed and signed by every applicant submitting fingerprints for non-criminal justice

purposes.

By submitting fingerprints, I consent to the collection and retention of my fingerprints in order to complete a

criminal history background check as part of the application process. I hereby request authorization from the

Office of the State Courts Administrator Court Interpreter Certification and Regulation Program and board (the

OSCA/CICRP) to undergo a Level 2 background check for purposes of determining initial registration and/or

renewal of registration in accordance with the standards prescribed by the Court Interpreter Certification Board.

I hereby authorize the OSCA/CICRP and/or an authorized and properly registered third-party service provider or

Livescan vendor to submit a set of my fingerprints to the Florida Department of Law Enforcement (FDLE) for the

purpose of accessing and reviewing Florida and national criminal history records that may pertain to me. I

understand that I would be able to receive any national criminal history record that may pertain to me, including

directly from the Federal Bureau of Investigation (FBI). I understand that my fingerprints will be retained at the

FDLE and the FBI for the purpose of providing notice of any subsequent modifications to your criminal history

record.

I acknowledge that I am entitled to challenge the accuracy and completeness of the criminal history record report

you receive, if any, with the reporting law enforcement agency, the FDLE and/or the FBI. I am aware that the

inappropriate release of criminal history information is prohibited and that procedures for obtaining a change,

correction, or updating of the FDLE or FBI criminal history are set forth in § 943.056, Fla. Stat., Fla. Admin. Code

11C-8.001 and Title 28, CFR, Section 16.34. I understand that I may obtain a prompt determination as to the

validity of my challenge with the reporting law enforcement agency and/or the FDLE before a final decision is

made about my status as a spoken language court interpreter.

Signature: __________________________________________________________ Date: _____________________

Printed Name: __________________________________________________ Date of Birth: ___________________

Address: ______________________________________________________________________________________

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III. AFFIRMATION STATEMENT AND SIGNATURE

I, affirm that the information supplied on this application and any

additional materials or information required as part of the biennial renewal process is correct; that to the best of my

knowledge, I qualify for the renewal for which I have applied; and that I will notify the Court Interpreter Certification

and Regulation Program (CICRP) within 30 days of any such event: a) address change; b) legal name change; c) felony or

first degree misdemeanor conviction; d) any change in the status of a professional license or certification which I

currently hold. I further certify that I have read, understand, and agree to abide by the Florida Rules for Certification

and Regulation of Spoken Language Court Interpreters.

I understand that any omissions, falsifications, misstatements, or misrepresentations of the information provided in this

application, or information required to be subsequently provided, may be grounds for revocation of registration and any

corresponding state-level designation.

I understand that the biennial renewal fee is non-refundable, pursuant to rule 14.110(g). However, the renewal fee ─

less $25 retained for administrative processing costs ─ will be returned to individuals who, upon review of their

applications, are deemed ineligible to renew their registration.

Must Be Signed in

Presence of Notary

Signature of Applicant:

Date:

IV. NOTARY AFFIDAVIT

State of

County of

Sworn to and subscribed before me this day of , 20 _, by

Name of Applicant

who is personally known to me, or who has produced

as identification.

Notary Seal

Notary Public

Commission Expires:

Name typed, printed, or stamped

Page 6 of 10

Court Interpreter Certification

and Regulation Program (CICRP)

Policy Receipt and Acknowledgement for the Background Check Screening

Process for Court Interpreters

The Florida Rules for Certification and Regulation of Spoken Language Court Interpreters require

interpreters to undergo and pass a background check according to standards prescribed by the board

and published in Board Operating Procedures. T he Court Interpreter Certification Board (Board) has

approved and adopted t he following Board Operating Procedure relating to the updated b ackground

check process:

“Effective November 18, 2022, all initial applicants for court interpreter registration, and all

registered-only renewal applicants are required to submit to a Level 2 criminal background check

conducted by the F lorida Department of Law Enforcement (FDLE).” This is to be accomplished

electronically at the applicant’s or interpreter’s expense.

I understand and agree:

Applicants must request authorization from the Court Interpreter Certification and Regulation

Program (CICRP) to

undergo a Level 2

background

check

for

purposes of

determining initial

registration and/or renewal of registration.

➢

Click

the following link

access the authorization

form

to request

the

CICRP’s Originating

Agency Identification

(ORI) number:

Level 2 Background Screening Originating Agency Identification (ORI) Authorization Request

Form.

➢

Complete the

ORI Request

for

Authorization

form

and

submit

via email it

to:

[email protected].

➢

Upon

successful

review

eligibility, CICRP staff

will issue an

ORI number

and

the applicant

can

proceed

with

the background

check

process.

Applicants are required

to go to a

Livescan

Service Provider

of their

choosing to be fingerprinted.

The list

providers throughout the

state

is found

at: https://www.fdle.state.fl.us/Criminal-History-

Records/Documents/InternetDoc_ServiceProviders_June.aspx. This list

should not

be seen

as an

endorsement

or recommendation

of one

product

or business

over another by the

board,

the Office

of State Court

Administrator,

or the

Supreme

Court of Florida,

and does

not imply any

rating,

ranking

or certification of

the products

or businesses

themselves. This list is provided

for

informational purposes

only. As provider prices will vary, applicants may wish

to compare

vendor

fee

schedules to obtain the

best

price. For

reference, in

addition

the Livescan

Service Providers

listed in

the link

above,

Livescan

fingerprints may also be

taken

your local law

enforcement

agencies (Police

Department

Sheriff’s

Office).

➢

The applicant

must

provide the

CICRP

Originating

Agency Identification

(ORI)

number

to the

local law

enforcement

agency or

Livescan

Service Provider

so that

the

background

screening results are

sent

directly

from

FDLE

to the

CICRP.

Page 7 of 10

➢

The cost of the background check is approximately $50 to $75 per person, which

includes the FDLE fee, and the cost charged by the Livescan provider to perform the

fingerprinting. As previously noted, the cost may vary depending on the Livescan

provider.

The CICRP will receive the background check results from FDLE within 3 days.

I understand that the failure to obtain a criminal background check within the time proscribed by the

board may result in administrative suspension of official state-level designation or registered st atus.

By signing below, I acknowledge th at I have read, agree, and understand that as a registered court

interpreter in the Sta te of Florida, I am r equired to complete the st eps and abide b y the p olicy stated

above, and set forth in the operating procedures adopted by the Court Interpreter Certification

Board.

Signature: Date: (MM/DD/YYYY)

Page 8 of 10

Court Interpreter Certification

and Regulation Program (CICRP)

Level 2 Background Screening Originating Agency Identification (ORI)

Authorization Request Form

Request for ORI Authorization

I ______________________________________________, am requesting authorization from the Office of

the State Courts Administrator Court Interpreter Certification and Regulation Program and Court Interpreter

Certification Board (the OSCA/CICRP) to obtain the CICRP ORI number and undergo a Level 2 background

check in accordance with the standards prescribed by the board.

Full Name:

Date of Birth (MM/DD/YYYY):

Driver’s License or State Identification Card

Number(s):

Signature: Date:

CICPR-Form-028

Effective: 03/28/2023

Page 9 of 10

Court Interpreter Certification

and Regulation Program (CICRP)

INTERPRETER OATH TO UPHOLD THE CODE OF PROFESSIONAL CONDUCT

PLEASE NOTE: CERTIFIED, LANGUAGE SKILLED AND PROVISIONALLY APPROVED INTERPRETERS ARE

EXEMPT FROM COMPLETING THIS FORM.

Please complete and submit this form with your registration application. Per rule 14.200(b)(4),

before any person’s registration may be approved, the interpreter shall take an oath to uphold the

Code of Professional Conduct contained in Part III, Florida Rules for Certification and Regulation

of Spoken Language Court Interpreters.

OATH OF INTERPRETER

I, , certify that I have

read, understand, and agree to abide by the Florida Rules for Certification

and Regulation of Spoken Language Court Interpreters, Part III, Code of

Professional Conduct.

Executed this day of , 20 .

Signature:

Affiant

Name:

Typed or printed

State of Florida

County of

Sworn to or affirmed under oath and subscribed before me this

day of , 20 , by ,

who is personally known to me, or who has produced as identification.

Signature of Notary Public

Printed Name, Stamp or Seal

Commission Expires:

Page 10 of 10