Arizona Administrative Code › Title 4 - PROFESSIONS AND OCCUPATIONS › Chapter 12 - Board of Funeral Directors and Embalmers › Article 2 - LICENSING PROVISIONS › Section R4-12-210 - Application for a Cremationist License

Current through Register Vol. 30, No. 28, July 12, 2024
An applicant for a cremationist license shall submit an
				  application packet to the Board that contains all of the following:
1. An application form provided by the Board,
				signed and dated by the applicant 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,
				address, and telephone number of the crematory or funeral establishment
				employing the applicant, if applicable;
e. 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 subsections (1)(f)(i) through (1)(f)(vi) for each
				felony;
f. Whether the applicant,
				within the five years before 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 and the:
i. Charged felony or misdemeanor;
ii. Date of conviction;
iii. Court that has 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;
g. 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;
h. Whether the applicant
				is currently incarcerated, on community supervision after a period of
				incarceration in a local, state, or federal penal institution, or on criminal
				probation;
i. 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 and 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;
j. 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 and 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;
k. Whether the applicant has ever
				surrendered a license, registration, certificate, or endorsement to the Board
				or any other state funeral licensing authority; and
l. A notarized statement by the applicant
				verifying that the information on the application is true and
				correct.