At least seven calendar days before a
Sanitarians Council meeting, an applicant for environmental health sanitarian
registration shall submit an application packet to the Department containing:
1. The following information in a
Department-provided format:
a. The
applicant's name, address, e-mail address, and telephone number;
b. If applicable, applicant's former
names;
c. The applicant's social
security number, required under A.R.S. §§
25-320 and
25-502;
d. If applicable, the applicant's current
employment information:
i. The employer's
name, address, e-mail address, and telephone number;
ii. The applicant's position title;
and
iii. The applicant's employment
start date;
e. If an
applicant meets the eligibility requirement in
R9-16-402(A)(1),
the following for each college or university where the applicant completed
semester credits or the equivalent credits from a college or university:
i. The college or university's name, address,
e-mail address, and telephone number;
ii. The number of natural science semester credits completed;
and
iii. If applicable, the degree
obtained;
f. If an
applicant meets the eligibility requirement in
R9-16-402(A)(2),
the following for each employer during the five years the applicant was
employed as a sanitarian aide:
i. The
employer's name, address, e-mail address, and telephone number;
ii. The name, title, e-mail address, and
telephone number of a contact individual for the employer;
iii. The applicant's position and description
of responsibilities; and
iv. The
months and years of employment;
g. If an applicant meets the eligibility
requirement in
R9-16-402(A)(3),
the following for each active military service assignment during the five years
the applicant held a military job position in the field of environmental
health:
i. The military branch name, address,
e-mail address, and telephone number;
ii. The name, title, e-mail address, and
telephone number of a contact individual from the military branch;
iii. The applicant's military job position
and description of responsibilities; and
iv. The months and years of active military
service assignments;
h.
If an applicant meets the eligibility requirement in
R9-16-402(A)(4),
the following for a sanitarian licensed in another state or jurisdiction:
i. The state, county, and city that issued
the applicant's current license as a sanitarian;
ii. The testing organization that
administered the sanitarian examination;
iii. The name of the sanitarian
examination;
iv. The sanitarian
examination administration date;
v.
The number of sanitarian examination questions;
vi. The sanitarian examination
score;
vii. The other eligibility
requirement in
R9-16-402(A)(1) through
(A)(3) met by the applicant; and
viii. As applicable, the information required
in subsection (B)(1)(e), (f), or (g);
i. If an applicant meets the eligibility
requirement in
R9-16-402(A)(5),
an applicant shall provide the following information:
i. The name of the testing center;
ii. The date the sanitarian examination was
completed;
iii. The sanitarian
examination score; and
iv. As
applicable, the information required in subsection (B)(1)(e), (f), or
(g);
j. Whether the
applicant is or has been licensed as a sanitarian in another state or
jurisdiction;
k. Whether the
applicant has had an application for licensure as a sanitarian denied in a
state or jurisdiction;
l. If the
applicant has had an application for licensure as a sanitarian denied, the:
i. Reason for denial;
ii. Date of the denial; and
iii. Name, address, and telephone number of
the licensing agency that denied the applicant's
application;
m. Whether
the applicant has had a license as a sanitarian suspended or revoked by a state
or jurisdiction or entered into a consent agreement with a state or
jurisdiction;
n. If the applicant
has had a license as a sanitarian suspended or revoked or entered into a
consent agreement, the:
i. Reason for the
suspension, revocation, or consent agreement;
ii. Date of the suspension, revocation, or consent agreement;
and
iii. Name, address, and
telephone number of the licensing agency that suspended, revoked, or entered
into a consent agreement with the applicant;
o. Whether the applicant has been convicted
of a felony or a misdemeanor related to the functions of the applicant's
employment or occupation as a sanitarian in this state or another
state;
p. If the applicant has been
convicted of a felony or a misdemeanor in subsection (o):
i. The date of the conviction,
ii. The state or jurisdiction of the
conviction,
iii. An explanation of
the crime of which the applicant was convicted, and
iv. The disposition of the
case;
q. Whether the
applicant agrees to allow the Department to submit supplemental requests for
additional information or documentation in
R9-16-407 ;
r. An attestation that:
i. The applicant authorizes the Department to
verify all information provided in the application packet, and
ii. The information submitted as part of the
application packet is true and accurate; and
s. The applicant's signature and date of
signature;
2. In addition
to the application in subsection (B)(1), the following:
a. A copy of applicant's Social Security
card;
b. Proof of U.S. citizenship
or alien status according to A.R.S. §
41-1080;
c. If applicable, a copy of an applicant's
sanitarian license issued by another state or jurisdiction;
d. If an official transcript is issued by a
college or university from outside of the United States or its territories,
documentation from a third party evaluation service verifying equivalent
credits identified in subsection (B)(1)(e);
e. If applicable, a letter verifying an
applicant's start and end dates of employment for each employer identified in
subsection (B)(1)(f);
f. If
applicable, a letter verifying an applicant's start and end dates of the
military job position for each active military service assignment identified in
subsection (B)(1)(g);
g. If
applicable, documentation of the completed sanitarian examination, including
the sanitarian examination test results, from the testing center or
jurisdiction that administered the sanitarian examination required by another
state or jurisdiction in subsection (B)(1)(h); and
h. If applicable, a copy of the official
notice from a testing center in subsection (B)(1)(i); and