Petition for Predetermination



Instructions for Submitting a Petition for Predetermination

A predetermination is a voluntary, written request by an individual to determine whether their criminal history will likely disqualify the individual from obtaining a license. Each petitioner’s criminal background will be considered using the following factors outlined in N.C.G.S. § 93B-8.1(b1):

  1. The level and seriousness of the crime;
  2. The date of the crime;
  3. The age of the person at the time of the crime;
  4. The circumstances surrounding the commission of the crime, if known;
  5. The nexus between the criminal conduct and the prospective duties of the applicant as a licensee;
  6. The prison, jail, probation, parole, rehabilitation, and employment records of the applicant since the date the crime was committed;

6a. The completion of, or active participation in, rehabilitative drug or alcohol treatment;

6b. A Certificate of Relief granted pursuant to G.S. § 15A-173.2;

  1. The subsequent commission of a crime by the applicant; and
  2. Any affidavits or other written documents, including character references

Predeterminations are not required and do not constitute a Final Agency Decision (FAD).

The Board will provide a predetermination within 45 days of receipt of the petition. The petitioner will be notified when the predetermination has been reached. Favorable predetermination is binding on the Board, provided that criminal history is correct and remains unchanged at time of application for licensure. If the Board predetermines that the petitioner’s criminal history is likely grounds for denial of a license, the Board will notify the petitioner in writing regarding the grounds for the predetermination, advise that the petitioner has the right to complete any requirements for licensure and apply to the Board to have their application considered by the Board under its application process, and that further evidence of rehabilitation will be considered upon application.

Required Documentation

  1. Complete both the Petition for Predetermination and Affirmation forms. Please note that the Affirmation requires a notarized signature.
  1. You must pay for and attach a criminal history record report obtained by CriminalRecordCheck.com, the Board’s approved independent vendor, that is no more than 60 days old. The fees charged for this report are paid to CriminalRecordCheck.com, the independent company supplying the report, not the Board. Charges for this report vary depending on where you have lived. Apply for a criminal history record report here:

https://orders.mycrc.com/c/p/unsolicited_portal?guid=hliHIa2SBYFXv2R3zls5mdsSh4IFOBkD

  1. For each crime identified in the criminal history record report, you must provide the following information:
  1. A) Whether the crime was a felony or misdemeanor;
(B) The date that the crime occurred;(C) The date you were convicted of, or plead guilty or nolo contendere to, the crime;

(D) Your age at the time of the crime;

(E) The circumstances surrounding the commission of the crime;

(F) The sentence imposed for the crime;

(G) The period of time during you were incarcerated for the crime;

(H) The period of time during you were on probation or parole for the crime;

(I) Any documentation related your rehabilitation or employment since the date of the crime;

(J) Whether you have undergone any rehabilitative drug or alcohol treatment since the date of the crime;

(K) Whether a Certificate of Relief has been granted regarding the crime, pursuant to G.S. 15A 173.2; and

(L) Any affidavits or other written documents, including character references.

  1. You must pay the Board a non-refundable petition fee of $45. The fee can be paid by credit card through the Board’s website at https://ncchiroboard.com/make-a-payment/renewals/predetermination-application/or by check made payable to the North Carolina Board of Chiropractic Examiners.

Additional Information

Please submit all required documentation in writing to:

North Carolina Board of Chiropractic Examiners

Attn: Licensing Specialist

6070 Six Forks Rd., Ste L

Raleigh, NC 27609

Incomplete petitions shall not be considered by the Board. If incomplete petitions received by the Board are not made complete within 30 days of receipt, the incomplete petitions will be returned to the person from whom the request was made.