Ariz. Admin. Code § 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;

b. e. Residence and practice addresses;

c. 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 information required in R4-15-303 ; and

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

Notes

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.