Arizona Administrative Code › Title 4 - PROFESSIONS AND OCCUPATIONS › Chapter 12 - Board of Funeral Directors and Embalmers › Article 2 - LICENSING PROVISIONS › Section R4-12-202 - Application for an Intern, an Embalmer, or a Funeral Director License

Current through Register Vol. 30, No. 28, July 12, 2024
A. An applicant for
				an intern, an embalmer, or a funeral director license shall submit an
				application packet to the Board that contains the information required in
				A.R.S. §
									32-1323,
				and the following:
1. An application form
				provided by the Board, signed and dated by the applicant, and notarized that
				contains:
a. The applicant's name, mailing
				address, telephone number, and social security number;
b. The applicant's date and place of
				birth;
c. Any prior name or alias
				of the applicant;
d. The name and
				address of the high school from which the applicant graduated and the
				graduation date or date applicant received a general equivalency
				diploma;
e. The name and address of
				the mortuary school from which the applicant graduated and graduation
				date;
f. The name, address, and
				telephone number of the funeral establishment employing the
				applicant;
g. Whether the applicant
				has ever been convicted of or entered into a plea of no contest to a class 1 or
				2 felony, including the information in subsection (A)(1)(h)(i) through
				(A)(1)(h)(vi);
h. Whether the
				applicant, within five years from the date of the application, has been
				convicted of or entered into a plea of no contest to a felony or to a
				misdemeanor that is reasonably related to the applicant's proposed area of
				licensure including the:
i. Charged felony or
				misdemeanor;
ii. Date of
				conviction;
iii. Court having
				jurisdiction over the felony or misdemeanor;
iv. Probation officer's name, address, and
				telephone number, if applicable;
v.
				A copy of the notice of expungement, if applicable; and
vi. A copy of the notice of restoration of
				civil rights, if applicable;
i. Whether the applicant, within five years
				from the date of the application, has committed any act involving dishonesty,
				fraud, misrepresentation, breach of fiduciary duty, gross negligence, or
				incompetence reasonably related to the applicant's proposed area of
				licensure;
j. Whether the applicant
				is currently incarcerated or on community supervision after a period of
				imprisonment in a local, state, or federal penal institution or on criminal
				probation;
k. Whether the
				applicant, within five years from the date of the application, has had an
				application for a license, registration, certificate, or endorsement denied or
				rejected by any state funeral licensing authority including the:
i. Reason for the denial or
				rejection,
ii. Date of the denial
				or rejection, and
iii. Name and
				address of the agency that denied or rejected the application;
l. Whether the applicant has,
				within five years from the date of the application, had a license,
				registration, certificate, or endorsement suspended or revoked by any state
				funeral licensing authority including the:
i.
				Reason for the suspension or revocation,
ii. Date of the suspension or revocation,
				and
iii. Name and address of the
				state licensing authority that suspended or revoked the license;
m. Whether the applicant has ever
				surrendered a license, registration, certificate, or endorsement to the Board
				or any state funeral licensing authority;
n. The dates the applicant served as an
				apprentice embalmer or intern, location of apprenticeship or internship, and
				the number of human bodies embalmed, if applicable;
o. A statement of whether the applicant has
				passed a national board examination or state equivalent examination, if
				applicable; and
p. A notarized
				statement by the applicant verifying the information on the application is true
				and correct;