Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 16 - DEPARTMENT OF HEALTH SERVICES - OCCUPATIONAL LICENSING › Article 4 - REGISTRATION OF ENVIRONMENTAL HEALTH SANITARIANS › Section R9-16-405 - Application for Sanitarian Examination and Registration

Current through Register Vol. 30, No. 28, July 12, 2024
A. An individual may apply to take the
				sanitarian examination for registration as a sanitarian if the individual meets
				one of the eligibility requirements in
				R9-16-402(A)(1)
				through (A)(3).
B. At least seven calendar days before a
				Sanitarians Council meeting, an applicant for environmental health sanitarian
				registration shall submit an application packet to the Department containing:
1. The following information in a
				Department-provided format:
a. The
				applicant's name, address, e-mail address, and telephone number;
b. If applicable, applicant's former
				names;
c. The applicant's social
				security number, required under A.R.S. §§
											25-320
				and
				25-502;
d. If applicable, the applicant's current
				employment information:
i. The employer's
				name, address, e-mail address, and telephone number;
ii. The applicant's position title;
				and
iii. The applicant's employment
				start date;
e. If an
				applicant meets the eligibility requirement in
				R9-16-402(A)(1),
				the following for each college or university where the applicant completed
				semester credits or the equivalent credits from a college or university:
i. The college or university's name, address,
				e-mail address, and telephone number;
ii. The number of natural science semester credits completed;
				and
iii. If applicable, the degree
				obtained;
f. If an
				applicant meets the eligibility requirement in R9-16-402(A)(2), the following
				for each employer during the five years the applicant was employed as a
				sanitarian aide:
i. The employer's name,
				address, e-mail address, and telephone number;
ii. The name, title, e-mail address, and
				telephone number of a contact individual for the employer;
iii. The applicant's position and description
				of responsibilities; and
iv. The
				months and years of employment;
g. If an applicant meets the eligibility
				requirement in
				R9-16-402(A)(3),
				the following for each active military service assignment during the five years
				the applicant held a military job position in the field of environmental
				health:
i. The military branch name, address,
				e-mail address, and telephone number;
ii. The name, title, e-mail address, and
				telephone number of a contact individual from the military branch;
iii. The applicant's military job position
				and description of responsibilities; and
iv. The months and years of active military
				service assignments;
h.
				If an applicant meets the eligibility requirement in
				R9-16-402(A)(4),
				the following for a sanitarian licensed in another state or jurisdiction:
i. The state, county, and city that issued
				the applicant's current license as a sanitarian;
ii. The testing organization that
				administered the sanitarian examination;
iii. The name of the sanitarian
				examination;
iv. The sanitarian
				examination administration date;
v.
				The number of sanitarian examination questions;
vi. The sanitarian examination
				score;
vii. The other eligibility
				requirement in
				R9-16-402(A)(1)
				through (A)(3) met by the applicant;
				and
viii. As applicable, the
				information required in subsection (B)(1)(e), (f), or (g);
i. If an applicant meets the eligibility
				requirement in
				R9-16-402(A)(5),
				an applicant shall provide the following information:
i. The name of the testing center;
ii. The date the sanitarian examination was
				completed;
iii. The sanitarian
				examination score; and
iv. As
				applicable, the information required in subsection (B)(1)(e), (f), or
				(g);
j. Whether the
				applicant is or has been licensed as a sanitarian in another state or
				jurisdiction;
k. Whether the
				applicant has had an application for licensure as a sanitarian denied in a
				state or jurisdiction;
l. If the
				applicant has had an application for licensure as a sanitarian denied, the:
i. Reason for denial;
ii. Date of the denial; and
iii. Name, address, and telephone number of
				the licensing agency that denied the applicant's
				application;
m. Whether
				the applicant has had a license as a sanitarian suspended or revoked by a state
				or jurisdiction or entered into a consent agreement with a state or
				jurisdiction;
n. If the applicant
				has had a license as a sanitarian suspended or revoked or entered into a
				consent agreement, the:
i. Reason for the
				suspension, revocation, or consent agreement;
ii. Date of the suspension, revocation, or consent agreement;
				and
iii. Name, address, and
				telephone number of the licensing agency that suspended, revoked, or entered
				into a consent agreement with the applicant;
o. Whether the applicant has been convicted
				of a felony or a misdemeanor related to the functions of the applicant's
				employment or occupation as a sanitarian in this state or another
				state;
p. If the applicant has been
				convicted of a felony or a misdemeanor in subsection (o):
i. The date of the conviction,
ii. The state or jurisdiction of the
				conviction,
iii. An explanation of
				the crime of which the applicant was convicted, and
iv. The disposition of the
				case;
q. Whether the
				applicant agrees to allow the Department to submit supplemental requests for
				additional information or documentation in
				R9-16-407;
r. An attestation that:
i. The applicant authorizes the Department to
				verify all information provided in the application packet, and
ii. The information submitted as part of the
				application packet is true and accurate; and
s. The applicant's signature and date of
				signature;