Ariz. Admin. Code § 4-12-202

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

Section R4-12-202 - Application for an Intern, an Embalmer, or a Funeral Director License

A. An applicant for an intern, an embalmer, or a funeral director license shall submit an application packet to the Board that contains the information required in A.R.S. § 32-1323, and the following:

1. An application form provided by the Board, signed and dated by the applicant, and notarized 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 and address of the high school from which the applicant graduated and the graduation date or date applicant received a general equivalency diploma;

e. The name and address of the mortuary school from which the applicant graduated and graduation date;

f. The name, address, and telephone number of the funeral establishment employing the applicant;

g. 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 subsection (A)(1)(h)(i) through (A)(1)(h)(vi);

h. Whether the applicant, within five years from 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 including the:

i. Charged felony or misdemeanor;

ii. Date of conviction;

iii. Court having 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;

i. 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;

j. Whether the applicant is currently incarcerated or on community supervision after a period of imprisonment in a local, state, or federal penal institution or on criminal probation;

k. 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 including 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;

l. 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 including 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;

m. Whether the applicant has ever surrendered a license, registration, certificate, or endorsement to the Board or any state funeral licensing authority;

n. The dates the applicant served as an apprentice embalmer or intern, location of apprenticeship or internship, and the number of human bodies embalmed, if applicable;

o. A statement of whether the applicant has passed a national board examination or state equivalent examination, if applicable; and

p. A notarized statement by the applicant verifying the information on the application is true and correct;

2. A copy of the applicant's high school or general equivalency diploma;

3. A copy of the transcript from each mortuary college attended by the applicant and, if applicable, each diploma issued to the applicant; and

4. The fee required by the Board.

B. In addition to the requirements in subsection (A), an applicant for an intern license shall submit on the application form the name and license number of the embalmer who will supervise the applicant.

C. In addition to the requirements in subsection (A), an applicant for an embalmer license shall submit to the Board:

1. On the application form:

a. Whether the applicant has embalmed 25 or more human bodies;

b. Apprenticeship or internship information including:

i. Beginning and ending dates,

ii. The state in which the apprenticeship or internship was served,

iii. The applicant's state registration number and date of issuance, and

iv. The number of human bodies embalmed by the applicant during the apprenticeship or internship;

c. The following information:

i. The name of each state in which the applicant has been licensed or registered as an embalmer or funeral director,

ii. The date of issuance of each funeral director or embalmer license or registration, and

iii. The license or registration number in each state in which the applicant is or has been licensed or registered as an embalmer or funeral director;

d. The name of each mortuary at which the applicant practiced as an embalmer or funeral director for five years immediately before the application date, beginning and ending dates of the practice, and a description of the practice, if applicable;

e. A notarized statement from a funeral director licensed or registered in any state that contains the funeral director's:

i. State in which licensed;

ii. License number and issuance date;

iii. Statement of length of time that the funeral director has known the applicant;

iv. Statement attesting to the applicant's good character, reputation, and professional ability; and

v. Recommendation for the Board's approval of the applicant; and

2. A report of apprenticeship or internship containing:

a. The applicant's name,

b. The name of the funeral establishment in which the apprenticeship or internship was served,

c. The name of the embalmer supervising the applicant,

d. The beginning and ending dates covered in the report,

e. The number of hours worked each month during the apprenticeship or internship,

f. The number of human bodies embalmed each month during the apprenticeship or internship, and

g. For each human body embalmed:

i. The name of the deceased,

ii. The date of death,

iii. A statement of whether an autopsy was performed, and

iv. The supervising embalmer's signature and license number,

D. In addition to the requirements in subsection (A), an applicant for a funeral director license shall submit to the Board a report containing:

1. The applicant's name;

2. The name of the funeral establishment in which one year of funeral directing experience was obtained;

3. The name of the responsible funeral director;

4. The beginning and ending dates covered in the report; and

5. For each burial, immediate burial, or direct cremation conducted by the applicant:

a. The name of the deceased;

b. The date of the burial, immediate burial, or direct cremation;

c. A statement of whether the applicant conducted a burial, immediate burial, or direct cremation; and

d. The supervising funeral director's signature and license number.

E. In addition to the requirements in subsection (A), an applicant for an embalmer or funeral director license who holds an out-of-state embalmer or funeral director license shall:

1. Submit on the application form, the name of each state in which the applicant is licensed or registered as an embalmer or funeral director; and

2. Arrange for the out-of-state licensing authority to complete the following on the application form to be submitted with the application packet:

a. Certification of current licensure of the applicant;

b. Type of license, license number, and date license was issued;

c. A statement of whether the applicant qualified by examination or by being licensed by another state;

d. A statement of whether the licensing authority has ever suspended, revoked, or taken any other action against the applicant's license; and

e. Notarized signature and title of agency official;

F. An applicant for a multiple funeral director license shall submit an application form that is signed and dated by the applicant, and notarized that includes the information in subsections (A)(1)(a) through (A)(1)(c) and:

1. The name and address of the funeral establishment for which the applicant:

a. Currently acts as the responsible funeral director, and

b. Is applying to act as the responsible funeral director;

2. The distance, stated in miles, between the current funeral establishment and the funeral establishment for which application is being made;

3. For the funeral establishment for which application is being made and for 12 months immediately preceding the application, the number of:

a. Funerals and cremations conducted at the funeral establishment, and

b. Transportations of human remains arranged through the funeral establishment;

4. The fee required by the Board; and

5. Other information required by the Board.

Ariz. Admin. Code § R4-12-202

Adopted effective September 18, 1987 (Supp. 87-3). Section repealed; new Section adopted by final rulemaking at 7 A.A.R. 1441, effective March 14, 2001 (Supp. 01-1).