Ariz. Admin. Code § R8-2-703 - Required Registration Information

The following information is the minimum information required to register as an emergency worker:

1. Full name;

2. Birth date;

3. Gender;

4. Social Security Number;

5. Citizenship, to include a document verifying citizenship;

6. Provide verification of eligibility to work in the United States;

7. Address;

8. Contact phone number and e-mail address;

9. Driver's license number, issuing state and expiration date;

10. Registering jurisdiction;

11. Registering agency/organization;

12. Employer name, address and phone number;

13. Personal reference name, address and phone number;

14. Emergency contact name, address and phone number;

15. Professional licenses, certificates and registrations, to include numbers and expiration dates (copies will be provided);

16. Court record of felony convictions;

17. Record of misdemeanor convictions involving moral turpitude; and

18. Medical conditions which may limit ability to perform as an emergency worker.

Notes

Ariz. Admin. Code § R8-2-703

Section made by final rulemaking at 14 A.A.R. 4519, effective January 31, 2009 (Supp. 08-4)