Section 16-85-72 - Application(a) An application for license shall be made under oath on a form to be provided by the board. The form shall require the applicant to provide; (1) The applicant's full name;(2) All applicable fees, including the application fee which shall not be refunded;(3) Evidence that the applicant is a graduate in podiatric medicine from a college approved by the Council on Podiatric Medical Education of the American Podiatric Medical Association;(4) Evidence of passage of all parts of the National Board of Podiatric Medical Examination (NB) and the Podiatric Medical Licensing Examination for States (PMLEXIS);(5) A report from the Federation of Podiatric Medical Boards relating to public action records;(6) Information regarding any conviction of any crime which has not been annulled or expunged;(7) If applicable, evidence of any licenses held or once held in other jurisdictions indicating the status of the license and documenting any disciplinary action; and(8) Any other information the board may require to investigate the applicant's qualifications for license.(b) It shall be the applicant's responsibility to furnish any information and documentation requested by the board. In the event of any change of information provided, the applicant shall notify the board of any change of information within thirty days of any change.(c) Every application and all references shall be signed by the applicant or the person attesting to the applicant's education, experience, and reputation.[Eff and comp 10/28/89; comp 8/25/90; am and comp 12/22/97] (Auth: HRS § 463E-12) (Imp: HRS §§ 463E-3, 463E-4)The amended version of this section by Hawaii Administrative Rules Listing of Filings, 2015-01, June, eff.6/22/2015 is not yet available.