Ala. Admin. Code r. 625-X-1-.01

Current through Register Vol. 43, No. 1, October 31, 2024

Section 625-X-1-.01 - Forms

All applicants for licensure shall submit to the Board the information requested on the official forms as approved by the Board, which at a minimum shall provide for:

(a) The name, permanent address and telephone number of the applicant;

(b) The business name, business address, phone number, and name of supervisor. The supervisor for an Occupational Therapy Assistant must be a currently licensed Occupational Therapist in the State of Alabama;

(c) A statement as to whether the applicant has been convicted of any felony offense denominated as such in any state or has been convicted of a misdemeanor or civil violation denominated as such involving an offense of moral turpitude in any state;

(d) A statement as to whether the applicant has been adjudged in a civil suit in a court in competent jurisdiction of malpractice or negligence in the practice of occupational therapy;

(e) A statement as to whether the applicant has previously been licensed as an Occupational Therapist or an Occupational Therapy Assistant, and whether said license as issued by another state has ever been revoked, suspended, probated, or otherwise voided.

Author: Alabama State Board of Occupational Therapy

Ala. Admin. Code r. 625-X-1-.01

Filed January 7, 1992. Amended: Filed October 15, 1999; effective November 19, 1999.

Statutory Authority:Code of Ala. 1975, § 34-39-5.