The petition shall be accompanied by a certification under penalty of perjury, signed and dated by the practice setting's administrative officer, whose name is printed below his/her signature, that the participating dentist has returned to full-time employment or, where the participating dentist has found subsequent employment, that the facility has entered into an agreement with the applicant for a minimum of three years; that the applicant can speak a Medi-Cal threshold language effectively in order to provide service; that it will pay the applicant a prevailing wage and not offset any loan repayments by the program against the applicant's salary; and that it is a "practice setting" as defined in Section 1971(f) of the code. The participating dentist will be required to sign a new or amended agreement required by section 1042.4(a).
The petition shall be accompanied by a certification under penalty of perjury, signed and dated by the practice setting's administrative officer, whose name is printed below his/her signature, that the participating dentist is still engaged in or has returned to full-time employment and that any restrictions on the license of the dentist do not interfere with the safe practice of dentistry. The Board shall review petitions and supporting documents. It shall notify the petitioning dentist in writing of its decision within 60 days after receipt of the petition.
Cal. Code Regs. Tit. 16, § 1042.4
Note: Authority cited: Sections 1614, 1970.5 and 1972, Business and Professions Code. Reference: Sections 1970.5, 1972 and 1975, Business and Professions Code.