Ariz. Admin. Code § 4-12-203

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

Section R4-12-203 - Application for an Embalmer's Assistant Registration

An applicant for an embalmer's assistant registration shall submit to the Board an application packet that contains the following:

1. An application form 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 each mortuary college attended by the applicant;

f. The name and address of the mortuary college from which the applicant graduated and graduation date;

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

h. 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;

i. Whether the applicant, within five years from the date of the application, has 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;

j. Whether the applicant, within five years from the date of the application, has surrendered a license, registration, certificate, or endorsement to the Board or any state funeral licensing authority;

k. The name of the applicant's current supervising embalmer;

l. If applicable, the beginning and ending dates the applicant served as an apprentice embalmer, the applicant's registration number and date of issuance, and the number of human bodies embalmed and date of each embalming; and

m. 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 and diploma from the mortuary college from which the applicant graduated;

4. A report of apprenticeship containing:

a. The applicant's name,

b. The name of the funeral establishment in which the apprenticeship was completed,

c. The name of the supervising embalmer,

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

e. The number of hours worked each month during the two most recent consecutive years of apprenticeship,

f. The number of human bodies embalmed by the applicant or in which the applicant assisted in the embalming for each month of the apprenticeship,

g. For each human body embalmed by the applicant or in which the applicant assisted in embalming for the two most recent consecutive years of the apprenticeship:

i. The name of the deceased,

ii. The date of death,

iii. A statement of whether an autopsy was performed,

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

v. The applicant's signature.

5. A completed and legible fingerprint card; and

6. The fee required by the Board.

Ariz. Admin. Code § R4-12-203

Former Rule, Section 3, Article III; Former Section R4-12-27 amended and renumbered as Section R4-12-203 effective June 16, 1981 (Supp. 81-3). Former Section R4-12-203 repealed and a new Section R4-12-203 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).