Section 433.330 - Contents of application for provisional certificateAn application for a provisional certificate must be submitted to the Division on a form furnished by the Division and must include:
1. For an applicant who is a natural person: (a) Three or more letters of professional reference;(b) A certification, signed by the applicant, that the applicant will maintain the confidentiality of information relating to any person who receives services;(c) Proof that the applicant has successfully completed a course in cardiopulmonary resuscitation according to the guidelines of the American Red Cross or American Heart Association;(d) Proof that the applicant is currently certified in standard first aid through a course from the American Red Cross or American Heart Association or, if the applicant submits proof that the course meets or exceeds the requirements of the American Red Cross or the American Heart Association, an equivalent course in standard first aid;(e) Written verification, on a form prescribed by the Division, that the fingerprints of the applicant were taken and forwarded electronically or by another means directly to the Central Repository for Nevada Records of Criminal History and that the applicant has given written permission to the law enforcement agency or other authorized entity taking the fingerprints to submit the fingerprints to the Central Repository for submission to the Federal Bureau of Investigation and to such other law enforcement agencies as the Division deems necessary for reports on the applicant's background to the Division and the applicant;(f) A copy of the social security card of the applicant;(g) Proof that the applicant has sufficient working capital to provide services for at least 3 months without compensation;(h) If applicable, a copy of the applicant's state business license and a copy of the current business license issued for the applicant's business by the county, city or town in which the applicant's business is located or written verification that the applicant is exempt from any requirement to obtain a business license; and(i) Any other information required by the Division.2. For an applicant other than a natural person:(a) If applicable, a copy of the state business license of the organization and a copy of the current business license issued for the applicant's business by the county, city or town in which the applicant's business is located or written verification that the applicant is exempt from any requirement to obtain a business license;(b) The federal tax identification number of the organization;(c) A copy of the bylaws, articles of incorporation, articles of association, articles of organization, partnership agreement, constitution and any other substantially equivalent documents of the applicant, and any amendments thereto;(d) A list of the members of the governing body of the applicant;(e) If the applicant is an association or a corporation: (1) The name, title and principal business address of each officer and member of its governing body;(2) The signature of the chief executive officer or an authorized representative; and(3) If the applicant is a corporation, the name and address of each person holding more than 10 percent of its stock;(f) For each member of the governing body:(1) Three or more letters of professional reference; and(2) Written verification, on a form prescribed by the Division, that the fingerprints of the member of the governing body were taken and forwarded electronically or by another means directly to the Central Repository for Nevada Records of Criminal History and that the member of the governing body has given written permission to the law enforcement agency or other authorized entity taking the fingerprints to submit the fingerprints to the Central Repository for submission to the Federal Bureau of Investigation and to such other law enforcement agencies as the Division deems necessary for reports on the member's background to the Division and the applicant;(g) Proof that the applicant has sufficient working capital to provide services for at least 3 months without compensation;(h) Copies of any policies and procedures of the applicant relating to the provision of services; and(i) Such other information as may be required by the Division.Nev. Admin. Code § 433.330
Added to NAC by Div. of Men. Health & Dev. Services by R090-16A, eff. 7/1/2017NRS 433.324 and sections 5 and 6 of Assembly Bill No. 46, chapter 269, Statutes of Nevada 2017, at page.