Ariz. Admin. Code § 4-15-205

Current through Register Vol. 30, No. 50, December 13, 2024
Section R4-15-205 - Application for Renewal of a License

An applicant for a renewal license shall submit:

1. An application form that contains the licensee's:
a. Name;
b. Massage therapy license number;
c. Massage therapy license expiration date;
d. Birthdate;
e. Residence and practice addresses;
f. Residence and practice telephone numbers;
g. Mailing address;
h. E-mail address;
i. Alien status declaration if the licensee is not a citizen or national of the United States;
j. Declaration of whether the licensee has been charged with or convicted of a felony or an offense involving moral turpitude or prostitution, solicitation, or a related offense or entered into a plea of no contest during the two-year period immediately preceding the renewal application date and, if so the licensee shall provide the following information:
i. The charged felony or offense;
ii. The date of conviction;
iii. The court having jurisdiction over the felony or offense;
iv. The 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 restoration of civil rights, if applicable;
k. Declaration that the licensee has completed the continuing education required by A.R.S. § 32-4225(E) during the two-year period immediately preceding the renewal application date or if audited, the documentation required in R4-15-303(B); and
l. Signature and date of submission; and

2. The fee required in R4-15-102(A).

Ariz. Admin. Code § R4-15-205

New Section made by final rulemaking at 12 A.A.R. 2759, effective September 9, 2006 (Supp. 06-3). Amended by final rulemaking at 20 A.A.R. 2246, effective 8/5/2014.