California Certification and National NCG Certification

All fields must be completed or the application cannot be submitted.

Fees

$275.00 Non-refundable Application and exam fee for California Certification and National NCG Certification

$150.00 Non-refundable Application and exam fee for California Certification (only if applicant already possesses NCG Certification)

$100.00 Non-refundable Re-examination Fee (Mark which exam(s) you must re-take)
NCG National Portion California State Portion NCG and California Portions

$35.00 Late Cancellation Fee

Full Name
(as you wish it to appear on your certificate)

Last Four Digits of Credit Card You Are Using to Pay

Exam Eligibility Number from the Professional Fiduciaries Bureau

Business/Firm Name:

Mailing Address:

City:

State:

Zip:

Telephone (where you wish to be contacted):

Fax Number:

Email Address:

Work Experience

Applicants should have at least one year of work experience in guardianship or a related field. (If you do not have the work experience requirement, see the next section under "education"). The information you provide will be verified through an affidavit process. You will be required to send the "Employer Affidavit" form to your current or past employer(s), or direct them to this website, for a copy of the affidavit form. The employer will be required to submit the affidavit form directly to CGC. List your experience over the past year providing guardianship of person or estate, or other related work experience, beginning with the most recent activities.

Employer Name/Address	Position	Start and end dates

Applicants without qualifying work experience may also become eligible through education or training. This information will be verified through a third-party vendor. Be sure you are accurate with the information you are submitting.

Proof of Current Employment/Experience

Please send one of the affidavits listed on the homepage of the CA application (depending upon how you obtained your experience) to a current or previous employer. They must complete the form provided and return it directly to CGC. You may not return it on their behalf.

Education

Graduate Degree
Concentration:		Year Awarded:
College/University:		City/State:
Upload proof of education(transcripts/diplomas/etc.):

Bachelors Degree
Major:		Year Awarded:
College/University:		City/State:
Upload proof of education(transcripts/diplomas/etc.):

Nursing Degree
Year Awarded:
School:		City/State:

Training
Include a listing of the dates, courses taken, program sponsors, locations, and number of hours completed for each course in the past two years.

Upload training document

Licensure and Certificates

1. Have you ever been issued a license or professional certificate (other than NCG/MCG) in any state?		Yes No
Type:	Governing Board/State:
Certificate Nbr:	Date Issued:
2. Have you ever had a license or professional certificate revoked, suspended, or subject to other discipline?			Yes No
If yes, please explain.

Q1. Have you ever been convicted or pled guilty or no contest to a felony? (CGC will be verifying this information through a criminal background check. Details will be provided in a separate e-mail.)

Yes
No

Q2. Have you ever been found civilly liable for an action of fraud, moral turpitude, misrepresentation, material omission, misappropriation, theft, or conversion?
If yes, please submit a letter of explanation, including the case number.

Yes
No

Q3. Have you ever been relieved of responsibilities as a guardian or conservator by a court, employer, or client for actions involving fraud, misrepresentation, material omission, misappropriation, theft, or conversion?
If yes, please submit a letter explaining the circumstances.

Yes
No

Q4. Are you bonded in accordance with California Statutes and local practice?

Yes
No

If no, please explain.

Q5. Have you ever been found liable in a subrogation action by an insurance or bonding agent?

Yes
No

If yes, please explain.

Q6. Do you have any special needs requiring CGC attention?

Yes
No

If yes, please explain.