[Attach Color Photo Here]STATE OF MISSOURI
The Board of Certified Court Reporters Examiners
APPLICATION FOR TEMPORARY CERTIFICATION
AS A
CERTIFIED COURT REPORTER
UNDER SUPREME COURT RULE 14.06(d) or 14.06(e)
(This application must be typed. If additional space is needed, please attach separate sheets.)
Enclose remittance of $100 (cashier check or money order) payable to the Clerk of the Supreme Court, P.O. Box 150, Jefferson City, MO 65102. FedEx address: 207 West High Street, Jefferson City, MO 65101
Last
Name
First
Middle
SSN
Street Address (Or P.O.
Box)
Apt. No.
City
State
Zip
Home Phone Work Phone
(Circle the correct response.)
Are you 18 years of age or
older? Yes
No
Are you a U.S. citizen? Yes No
If not, name the document that establishes your identity and employment
eligibility to work
in the U.S.
Have you ever been convicted of a felony?
Yes No
Do you have a disability which could necessitate your need for
assistance? Yes No
COURT REPORTING EDUCATIONAL BACKGROUND
Name of School or Training:
Location:
LIST EMPLOYMENT FOR PRIOR TWO YEARS, BEGINNING WITH MOST RECENT
(1)
Employer
Phone No. From
to
Position
If self-employed, give details
and length of time so engaged
Name of Company
Street Address
City, State, Zip
(2)
Employer
Phone No. From
to
Position
If self-employed, give details
and length of time so engaged
Name of Company
Street Address
City, State, Zip
SYSTEM
OF REPORTING: Stenotype
Stenomask COMPUTER
AIDED TRANSCRIPTION: Yes
No
This application will be returned to you if any information requested is not
provided in full.
Attached hereto is documentation verifying that I am attending or I have recently completed education/training in court reporting. [Please attach a copy of the certificate issued by the school/training program or a notarized statement from your tutor/mentor.]
I understand that a temporary certificate as a certified court reporter under the provisions of Supreme Court Rule 14.06(d) or Supreme Court Rule 14.06(e) shall be valid for 24 months and shall not be renewable.
Date Signed