Ala. Admin. Code r. 625-X-3-.02

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

Section 625-X-3-.02 - Forms

All applicants for limited permit 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. Said supervisor 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 of competent jurisdiction, of malpractice or negligence in the practice of occupational therapy;

(e) A statement as to whether the applicant has been issued a license, limited permit or any form of a provisional license as an Occupational Therapist or Occupational Therapy Assistant, and whether said license, limited permit or provisional license as issued by another state has ever been revoked, suspended, probated, or otherwise voided.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-3-.02

Filed January 7, 1992. Amended: Filed December 18, 1995; effective January 22, 1996. Amended: Filed October 15, 1999; effective November 19, 1999.

Statutory Authority:Code of Ala. 1975, § 34-39-11.