Form AOC-A-234 "License/Certification Acknowledgement" - North Carolina

What Is Form AOC-A-234?

This is a legal form that was released by the North Carolina Court System - a government authority operating within North Carolina. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2009;
  • The latest edition provided by the North Carolina Court System;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form AOC-A-234 by clicking the link below or browse more documents and templates provided by the North Carolina Court System.

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Download Form AOC-A-234 "License/Certification Acknowledgement" - North Carolina

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STATE OF NORTH CAROLINA
LICENSE/CERTIFICATION
JUDICIAL BRANCH OF GOVERNMENT
North Carolina Administrative Office of the Courts
ACKNOWLEDGEMENT
Human Resources Division
P. O. Box 2448
Raleigh, NC 27602
Phone: (919) 890-1100
Courier Box 56-10-50
Fax: (919) 890-1906
HumanResources@aoc.nccourts.o
PURPOSE: The purpose of this form is to ensure that employees whose position or rate of pay is dependent upon being licensed or
certified are aware of the requirement to maintain an active license/certification throughout their employment with the
Judicial Branch.
INSTRUCTIONS: Complete and initial all parts of the document
Employee Name
Social Security Number (last 4 digits only)
Social Security Number (last 4 digits only)
Job Title
Office/County/District
Office/County/District
License/Certification (include license/certification number, if applicable)
License/Certification Issued by: (state, organization, etc.)
I understand that:
I am being paid at a higher rate of pay due to the fact that I have an active license/certification (listed above).
Initial
I am required to maintain an active license/certification during my employment with the Judicial Branch.
Initial
If my license/certification should become inactive or I am suspended, disbarred or I am no longer
licensed/certified, that I will notify NCAOC Human Resources immediately so that my salary can be adjusted
Initial
for unlicensed or non-certified persons in my position.
If NCAOC Human Resources should become aware that my license/certification has become inactive or that
I am suspended, disbarred or I am no longer licensed/certified that NCAOC Human Resources will take
Initial
appropriate action to adjust my salary to the appropriate amount or any other appropriate action.
My salary will be reduced, if applicable, effective the date I was no longer licensed/certified and that NCAOC
will recoup any monies earned by me from the date I was no longer licensed/certified until the date my salary
Initial
is reduced or my employment terminated.
If my license/certification is no longer active or I am no longer licensed/certified and my position requires
such license/certification to perform my job duties that my hiring authority may terminate my employment.
Initial
Signature Of Employee
Date Signed
HIRING AUTHORITY ACKNOWLEDGEMENT
Name Of Hiring Authority (Type Or Print)
Signature Of Hiring Authority
Date Signed
AOC-A-234, New 10/09
© 2009 Administrative Office of the Courts
STATE OF NORTH CAROLINA
LICENSE/CERTIFICATION
JUDICIAL BRANCH OF GOVERNMENT
North Carolina Administrative Office of the Courts
ACKNOWLEDGEMENT
Human Resources Division
P. O. Box 2448
Raleigh, NC 27602
Phone: (919) 890-1100
Courier Box 56-10-50
Fax: (919) 890-1906
HumanResources@aoc.nccourts.o
PURPOSE: The purpose of this form is to ensure that employees whose position or rate of pay is dependent upon being licensed or
certified are aware of the requirement to maintain an active license/certification throughout their employment with the
Judicial Branch.
INSTRUCTIONS: Complete and initial all parts of the document
Employee Name
Social Security Number (last 4 digits only)
Social Security Number (last 4 digits only)
Job Title
Office/County/District
Office/County/District
License/Certification (include license/certification number, if applicable)
License/Certification Issued by: (state, organization, etc.)
I understand that:
I am being paid at a higher rate of pay due to the fact that I have an active license/certification (listed above).
Initial
I am required to maintain an active license/certification during my employment with the Judicial Branch.
Initial
If my license/certification should become inactive or I am suspended, disbarred or I am no longer
licensed/certified, that I will notify NCAOC Human Resources immediately so that my salary can be adjusted
Initial
for unlicensed or non-certified persons in my position.
If NCAOC Human Resources should become aware that my license/certification has become inactive or that
I am suspended, disbarred or I am no longer licensed/certified that NCAOC Human Resources will take
Initial
appropriate action to adjust my salary to the appropriate amount or any other appropriate action.
My salary will be reduced, if applicable, effective the date I was no longer licensed/certified and that NCAOC
will recoup any monies earned by me from the date I was no longer licensed/certified until the date my salary
Initial
is reduced or my employment terminated.
If my license/certification is no longer active or I am no longer licensed/certified and my position requires
such license/certification to perform my job duties that my hiring authority may terminate my employment.
Initial
Signature Of Employee
Date Signed
HIRING AUTHORITY ACKNOWLEDGEMENT
Name Of Hiring Authority (Type Or Print)
Signature Of Hiring Authority
Date Signed
AOC-A-234, New 10/09
© 2009 Administrative Office of the Courts