Neb. Admin. Code PROFESSIONAL PRACTICES COMMISSION, tit. 95, ch. 1, app A
BEFORE THE NEBRASKA PROFESSIONAL PRACTICES COMMISSION STATE OF NEBRASKA
)
_________________________) Case No. ___(leave blank)___
(Name of Commissioner))
) PETITION
COMMISSIONER OF EDUCATION,)
____________________________________)
(Address))
____________________________________)
Petitioner,)
vs.)
____________________________________)
(Name))
____________________________________)
(Address))
____________________________________,)
Respondent.
Petitioner, in accordance with Title 95, Chapter 01, of the Nebraska Administrative Code, states and alleges as follows:
1. The full name, address, and telephone number of the Petitioner;
2. The full name, address, telephone number, and social security number, if known, of the Respondent;
3. The type, rank, level, endorsements, and expiration dates of certificate(s) held by Respondent;
4. The name of the school or school district, if any, currently employing the Respondent;
5. A concise statement of the facts which the Petitioner believes constitutes a violation of professional ethics and/or practices; and
6. Citation of the statute (s) or rule (s) which was allegedly violated.
WHEREFORE, the Petitioner requests that the Professional Practices Commission hold hearings and make recommendations to the State Board of Education as is warranted, regarding the certificate(s) of Respondent.
Dated this__________ Day of ___________, 19____ .
(signature)
(name)
Commissioner of Education
Department of Education
State of Nebraska
VERIFICATION
State of Nebraska)
)
County of)
I, __________, Commissioner of Education, being first duly sworn under oath, state that I have read the contents of the Petition and that to the best of my knowledge, information, and belief such contents are true and there is reasonable cause for filing said document.
Subscribed and sworn before me this__________ day of____________, 19_____, by _______(name of Commissioner)_______.
(Seal)
______________________________
Notary Public
CERTIFICATE OF SERVICE
I certify that a copy of the foregoing Petition was served upon Respondent by______________ this__________ day of___________, 19_____.
_________________________
(signature)
Neb. Admin. Code PROFESSIONAL PRACTICES COMMISSION, tit. 95, ch. 1, app A