Mississippi Administrative Code › Title 30 - Professions and Occupations › Part 2703 - Licensure, Regulations, and Administrative Hearings › Chapter 1 - Licensure › Rule 30-2703-1.2 - Application(s)

Current through June 25, 2024
A. Administrator-in-Training (A.I.T.)
				Application
An applicant for the A.I.T. Program shall file a written or
				  electronic application, on the forms prescribed and furnished by the Board, pay
				  all applicable fees, and furnish evidence satisfactory to the Board that he or
				  she has met all licensure requirements as specified in Rule l.l.A.(l) - (6) of
				  Chapter 1, Part 2703 of these Rules and Regulations. The application form is
				  available from the Board office or the Board website.
The applicant shall submit to the Board the following:
(1) satisfactory proof of age, which
				must accompany the application;
(2) letters from three (3) references, who
				shall certify to the good moral character of the applicant, and shall be from
				individuals who have engaged in either business or professional work with the
				applicant, but shall not be related by blood or marriage;
(3) a statement, which must accompany the
				application from the applicant's physician as to the health of the applicant,
				specifically, his or her physical ability to perform the duties of a nursing
				home administrator;
(4) a finished
				unmounted recent photograph of himself or herself for identification. This
				photograph must be attached to the application, must not be less than 2" x 3"
				in size and must be signed by the applicant on the back;
(5) a transcript, bearing the official seal
				of the educational institution, which must be submitted to the Board office
				directly from the institution, for the purpose of documenting successful
				completion of college credits by the applicant;
(6) if applicable, a signed statement from
				the applicant's current nursing home administrator describing the duties the
				applicant has performed, the number of employees he or she has supervised, and
				any other information concerning the applicant's work experience for at least
				the past two (2) consecutive years immediately prior to making application with
				the Board.
(7) payment for the
				current application fee in the amount set forth on the application to cover the
				costs associated with processing the application. The fee which is
				non-refundable, must accompany the A.I.T. application.
(8) Satisfactory proof that:
(a) a criminal records check that has been
				performed on the applicant to be sent directly to the Board's administrative
				office directly from the employing institution. This document must be signed
				and notarized; or
(b) a state and
				federal criminal background to be sent to the Board's administrative office
				directly from the appropriate governmental agency.
The applicant shall be responsible for the payment of any
				  fees or costs associated with the state and federal criminal record checks.
				  Such costs or fees shall be paid by the applicant to the agency completing the
				  record check. Criminal record checks must have been performed on the applicant
				  within six (6) months immediately prior to the filing of the
				  Administrator-in-Training Program Application or the Endorsement Application or
				  a new criminal record check shall be required.
(9) if the applicant has at any time held a
				certification or license, he or she must provide satisfactory proof that no
				formal discipline has been taken against any and all of those certifications or
				licenses.
(10) a completed
				Certificate of Employment form and A.I.T./ Preceptor Agreement form, or proof
				of completion of an equivalent A.I.T. program in Long Term Care Administration
				from an academic institution as stated in Part 2703, Chapter 1, Rule
				l.lA.(6)(b). The appropriate document must accompany the application.