Form DBPR BCAIB11 "Application for Authorization to Take the Principles and Practice Examination for Individuals Seeking Licensure Through an Internship Certification Program" - Florida

What Is Form DBPR BCAIB11?

This is a legal form that was released by the Florida Department of Business & Professional Regulation - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2018;
  • The latest edition provided by the Florida Department of Business & Professional Regulation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DBPR BCAIB11 by clicking the link below or browse more documents and templates provided by the Florida Department of Business & Professional Regulation.

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Download Form DBPR BCAIB11 "Application for Authorization to Take the Principles and Practice Examination for Individuals Seeking Licensure Through an Internship Certification Program" - Florida

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State of Florida
Department of Business and Professional Regulation
Building Code Administrators and Inspectors Board
Application for Authorization to Take the Principles and Practice Examination for Individuals
Seeking Licensure through an Internship Certification Program
Form # DBPR BCAIB 11
APPLICATION CHECKLIST – IMPORTANT – Submit all items on the checklist below with your
application to ensure faster processing.
APPLICATION REQUIREMENTS
This application should only be completed by individuals entering an internship certification
program who do not intend to apply for a provisional license for the duration of the internship.
WORK EXPERIENCE
Work experience detail is often too general and is missing hands-on experience. The person
certifying your experience should be specific when explaining your duties and actual hands on
experience. In order to process your application more quickly, and not have your application
returned to you, describe work experience in detail including hands-on, supervisory or
management responsibilities.
If the person attesting to your work experience is not Florida
licensed, submit a copy of their license from issuing authority.
Please mail your completed application, documentation and required fee(s) to:
Department of Business and Professional Regulation
2601 Blair Stone Road
Tallahassee, FL 32399-0783
BCAIB 11 Application for Authorization to Take the Principles and Practice Examination for Individuals Seeking Licensure through
an Internship Certification Program
Eff. date: August 2018
Incorporated by Rule: 61-35.008
1 of 11
State of Florida
Department of Business and Professional Regulation
Building Code Administrators and Inspectors Board
Application for Authorization to Take the Principles and Practice Examination for Individuals
Seeking Licensure through an Internship Certification Program
Form # DBPR BCAIB 11
APPLICATION CHECKLIST – IMPORTANT – Submit all items on the checklist below with your
application to ensure faster processing.
APPLICATION REQUIREMENTS
This application should only be completed by individuals entering an internship certification
program who do not intend to apply for a provisional license for the duration of the internship.
WORK EXPERIENCE
Work experience detail is often too general and is missing hands-on experience. The person
certifying your experience should be specific when explaining your duties and actual hands on
experience. In order to process your application more quickly, and not have your application
returned to you, describe work experience in detail including hands-on, supervisory or
management responsibilities.
If the person attesting to your work experience is not Florida
licensed, submit a copy of their license from issuing authority.
Please mail your completed application, documentation and required fee(s) to:
Department of Business and Professional Regulation
2601 Blair Stone Road
Tallahassee, FL 32399-0783
BCAIB 11 Application for Authorization to Take the Principles and Practice Examination for Individuals Seeking Licensure through
an Internship Certification Program
Eff. date: August 2018
Incorporated by Rule: 61-35.008
2 of 11
Instructions
If you have any questions or need assistance in completing this application, please contact the
Department of Business and Professional Regulation, Customer Contact Center, at 850.487.1395.
1. General Requirements:
a. If you are seeking certification as a building code inspector or plans examiner by completing
an internship certification program, you must be employed full-time by a municipality, county,
or other governmental jurisdiction, under the direct supervision of a certified building official.
b. The government entity must be Board-approved as a provider of an internship certification
program.
c. Proof of graduation with a related vocational degree or college degree or verifiable work
experience may be exchanged for the internship experience requirement year-for-year, but
may not reduce the internship to less than one (1) year.
d. Applicants must pass an exam administered by the International Code Council (ICC) in the
certification category sought prior to entering an internship certification program.
e. All applicants must pass both the Principles and Practice exam and a Board-approved 40-
hour code training course in the code category sought prior to completing the internship
certification program.
f.
Upon completion of an internship certification program, the applicant shall obtain a favorable
recommendation from the supervising building official, on jurisdictional letterhead.
g. At least 30 days and no more than 60 days prior to the completion of the internship, an
applicant shall apply to the Board for standard certification on Form # DBPR BCAIB 12.
h. If you are a building code inspector or plans examiner who holds a standard certification, you
may seek an additional certification in another category by completing an additional non-
concurrent one (1) year internship certification program in the certification category sought,
by passing an exam administered by ICC, and by completing a board-approved 40-hour code
training course in the license category sought.
2. Application Instructions (by section)
a. Section I – Application Type
i.
Indicate which category of licensure is being applied for. Select only one discipline per
application.
ii.
Complete the internship certification program number in the space provided and the
expected life of the internship certification program in years, not to exceed four years and
not to be less than one year.
iii.
Indicate if education and/or work experience will be considered in determining the life of
the internship certification program.
iv.
If special testing accommodations are required, contact the Department at 850.488.5952.
b. Section II – Applicant Personal Information
v.
Fill out each section completely. A Social Security number is required in order to apply
for any individual license within the Department of Business and Professional Regulation.
vi.
In the Full Legal Name section provide your full legal name as it appears on your Social
Security card. Do not use any nicknames or initials. Please list any aliases or prior names
in the Prior Name Information section.
vii.
Provide your mailing address. This will be used for sending correspondence regarding
your application and license.
viii.
Contact information is often used to quickly resolve questions with applications by
telephone call or email. If contact information is not provided, questions regarding
applications will be mailed to the applicant’s mailing address and may take longer to
resolve.
ix.
Additional contact information is optional and will be used when the applicant cannot be
reached using their primary contact information.
x.
Applicants must provide information on current or prior licenses held in Florida or any
other state, territory, or jurisdiction of the United States or in any foreign national
jurisdiction.
xi.
Applicants must provide information on any prior names or aliases used by applicant. If
the name on supporting documentation does not match the applicant’s legal name, the
alias used in the supporting documentation must be provided in this section. Failure to do
so will result in a deficient application.
BCAIB 11 Application for Authorization to Take the Principles and Practice Examination for Individuals Seeking Licensure through
an Internship Certification Program
Eff. date: August 2018
Incorporated by Rule: 61-35.008
3 of 11
b. Section III – Employment History
i.
Make sure that you clearly describe your work experience on the application form. Each
section must be filled out completely. If you do not have enough space to list all of your
experience history, you may submit additional copies of that section as necessary.
c. Section IV – Education
i.
List your educational history, if applicable.
ii.
If you intend to use any post-secondary education to qualify for the examination or
reduce the length of an internship program, you must have your college/university or
vocational school forward an official transcript to the Central Intake Unit for consideration.
d. Section V – Background Information
i.
Applicants must submit answers to each of the background questions.
ii.
For each “Yes” answer the person must provide an explanation in Section VI or VII, as
applicable.
e. Section VI – Explanation for Background Question 1
i.
For this section, provide as much detail as possible.
ii.
Question 1:
If you answer “yes” to this question, you must complete Section VI [make additional
copies as necessary] of the application. Please provide the full details of the criminal
charges including dates, outcomes, sentences, and/or conditions imposed; the dates,
name and location of the court and/or jurisdiction in which any proceedings were held or
are pending. If you answer “NO” to this question because you believe that previous
incidents have been dismissed, no action taken, nolle prossed, or expunged, you may be
asked to supply documentation as proof of the disposition.
f.
Section VII – Explanation for Background Questions 2-4
i.
For this section, provide as much detail as possible.
ii.
Question 2:
If you answer “yes” to this question, you must complete Section VII [make additional
copies as necessary] of the application and provide a copy of the judgment or decree.
You must also supply documentation proving all sanctions have been served and
satisfied, or if not, stating the current status of any proceedings.
iii.
Question 3:
If you answer “yes” to this question, you must complete Section VII [make additional
copies as necessary] of the application and supply copies of documentation explaining
the denial or pending action.
iv.
Question 4:
If you answer “yes” to this question, you must complete Section VII [make additional
copies as necessary] of the application and supply copies of the order(s) showing the
disciplinary action taken against the license, or documentation showing the status of the
pending action.
g. Section VIII – Work Experience
i.
Please use the Work Experience form to document your work experience. The
experience detail must be completed by the licensed building official, licensed contractor,
licensed fire marshal, licensed architect or licensed engineer who has knowledge of your
duties. Any work experience submitted for a reduction in the internship program must be
fully documented.
ii.
Be sure to list your current employer on the application. You must submit experience
detail verifying your current position with the city/county.
iii.
Work experience detail is often too general and is missing hands-on experience. The
person certifying your experience should be specific when explaining your duties and
actual hands on experience. In order to process your application more quickly, and not
have your application returned to you, describe work experience in detail including
hands-on, supervisory or management responsibilities.
If the person attesting to your
work experience is not Florida licensed, submit a copy of their license from issuing
authority.
h. Section IX – Affirmation by Written Declaration
i.
Applicant must sign the Affirmation by Written Declaration.
BCAIB 11 Application for Authorization to Take the Principles and Practice Examination for Individuals Seeking Licensure through
an Internship Certification Program
Eff. date: August 2018
Incorporated by Rule: 61-35.008
4 of 11
State of Florida
Department of Business and Professional Regulation
Building Code Administrators and Inspectors Board
Application for Authorization to Take the Principles and Practice Examination for Individuals
Seeking Licensure through an Internship Certification Program
Form # DBPR BCAIB 11
If you have any questions or need assistance in completing this application, please contact the
Department of Business and Professional Regulation, Customer Contact Center, at 850.487.1395.
For additional information see the Instructions at the beginning of this application.
Section I – Application Type
CHECK TRANSACTION REQUESTED
Authorization to Take the Principles and Practice Examination
CHECK INTERNSHIP CATEGORY
(only one category may be selected per application)
Inspector Categories [5001/1016]
Plans Examiner Categories [5002/1016]
Building
Building Plans
Mechanical
Mechanical Plans
Plumbing
Plumbing Plans
Electrical
Electrical Plans
INTERNSHIP CERTIFICATION PROGRAM
Approved internship certification program number ______________________
Applicant requests the life of this internship certification program for a period of __________ years.
Note: The life of an internship certification program cannot exceed four (4) years.
SPECIAL TESTING ACCOMMODATIONS
If you require special testing accommodations due to disability or if you have a religious conflict with the
scheduled examination date, please contact the Bureau of Education and Testing immediately at
850.488.5952 for detailed information.
BCAIB 11 Application for Authorization to Take the Principles and Practice Examination for Individuals Seeking Licensure through
an Internship Certification Program
Eff. date: August 2018
Incorporated by Rule: 61-35.008
5 of 11
Section II – Applicant Personal Information
PERSONAL INFORMATION
Social Security Number*
FULL LEGAL NAME
Last Name
First
Middle
Suffix
Birth Date (MM/DD/YYYY)
Gender
 Male  Female
/
/
MAILING ADDRESS
Do you wish to mark your address private, pursuant to
YES
NO
Section 119.071(4)(d)2.g., Florida Statutes?
Street Address or P.O. Box
City
State
Zip Code (+4 optional)
County (if Florida address)
Country
CONTACT INFORMATION
Primary Phone Number
Primary E-Mail Address
ADDITIONAL CONTACT INFORMATION (OPTIONAL)
Alternate Phone Number
Fax Number
Alternate E-Mail Address
CURRENT/PRIOR LICENSE INFORMATION
If you currently hold or have previously held a business or professional license/registration in Florida or
elsewhere, please list each one below (attach additional copies of this page as necessary):
1. License/Registration Type
State
Date (From)
Date (To)
/
/
/
/
License Number
Name Used
2. License/Registration Type
State
Date (From)
Date (To)
/
/
/
/
License Number
Name Used
3. License/Registration Type
State
Date (From)
Date (To)
/
/
/
/
License Number
Name Used
PRIOR NAME INFORMATION
Have you used, been known as, or are currently known by another name (example - maiden name,
nickname) or alias other than the name signed to the application? 
Yes
No
If your answer is yes, state name or names used below:
Last Name
First
Middle
Title
Suffix
Last Name
First
Middle
Title
Suffix
Last Name
First
Middle
Title
Suffix
* The disclosure of your Social Security number is mandatory on all professional and occupational license applications, is solicited
by the authority granted by 42 U.S.C. §§ 653 and 654, and will be used by the Department of Business and Professional Regulation
pursuant to §§ 409.2577, 409.2598, 455.203(9), and 559.79(3), Florida Statutes, for the efficient screening of applicants and
licensees by a Title IV-D child support agency to assure compliance with child support obligations. It is also required by § 559.79(1),
Florida Statutes, for determining eligibility for licensure and mandated by the authority granted by 42 U.S.C. § 405(c)(2)(C)(i), to be
used by the Department of Business and Professional Regulation to identify licensees for tax administration purposes.
BCAIB 11 Application for Authorization to Take the Principles and Practice Examination for Individuals Seeking Licensure through
an Internship Certification Program
Eff. date: August 2018
Incorporated by Rule: 61-35.008
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