Ariz. Admin. Code § 4-12-210

Current through Register Vol. 30, No. 45, November 8, 2024

Section R4-12-210 - Application for a Cremationist License

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.

2. A copy of a certificate of completion of a crematory certification program issued by:

a. The manufacturer of a retort, or

b. An accredited organization that provides instruction for crematory operation;

3. A completed and legible fingerprint card; and

4. The fee required by the Board under A.R.S. § 32-1309.

Ariz. Admin. Code § R4-12-210

New Section made by final rulemaking at 10 A.A.R. 681, effective April 3, 2004 (Supp. 04-1).