Current through Register Vol. 30, No. 38, September 20, 2024
At least 30 days before a regularly scheduled board meeting
date, an applicant for a dispensing optician's license by examination shall
submit to the Board an application packet that contains:
1. An application form provided by the Board,
signed and dated by the applicant, that contains:
a. The applicant's name, Social Security
number, address, and telephone number;
b. The name and address of the applicant's
employer at the time of application, if applicable;
c. If demonstrating technical skill and
training under A.R.S. §
32-1683(5)(b),
the name and address of each dispensing optician, physician, or optometrist for
whom the applicant served as an apprentice for three of the six years
immediately preceding the application date, and the beginning and ending dates
of each apprenticeship;
d. If
demonstrating technical skill and training under A.R.S. §
32-1683(5)(c),
the name and address of the school from which the applicant graduated, dates of
attendance, date of graduation, degree received, and the name and address of
each dispensing optician for whom the applicant served as a dispensing optician
apprentice for one of the six years immediately preceding the application date
and the beginning and ending dates of service. The applicant shall submit a
photocopy of the applicant's diploma from the optical dispensing
school;
e. If demonstrating
technical skill and training under A.R.S. §
32-1683(5)(c)
received during military service, the name
and address of the school from which the applicant graduated, dates of
attendance, date of graduation, and degree received, the location and name of
the duty station at which the applicant has worked for three of the six years
immediately preceding the application date and the beginning and ending dates
of service.
f. If demonstrating
technical skill and training under A.R.S. §
32-1683(5)(d),
the name and address of each dispensing optician, physician, or optometrist for
whom the applicant has worked for three of the six years immediately preceding
the application date and the beginning and ending dates of
employment;
g. A statement of
whether the applicant has ever been convicted of a felony or of a misdemeanor
involving moral turpitude in any state;
h. A statement of whether the applicant has
ever had an application for a professional license denied or had a license
suspended or revoked in any state; and
i. A sworn statement by the applicant
verifying the truthfulness of the information provided by the
applicant;
2. A
photocopy of the applicant's:
a. High school
diploma or general educational diploma issued in any state; or
b. Transcripts from a high school or college;
or
c. Evidence of a college degree
or admission to any college in any state;
3. Verification of passing both spectacle and
contact lens written and practical examinations in opticianry administered by a
nationally recognized body as evidenced by an original notice of examination
results or a copy of the original certificate of passage issued by the
organization that prepared the examination;
4. A letter attesting to good moral character
from each of three individuals who are not family members, who have known the
applicant for two years immediately before the date of the application, and
support the applicant's licensure;
5. A letter from each physician, optometrist,
or dispensing optician named in subsection (1)(c), (d), or (e) that contains:
a. The individual's printed name, address,
and telephone number; and
b. A
statement that the applicant has either served as an apprentice or been
employed as a dispensing optician by the physician, optometrist, or dispensing
optician for the time required in subsection (1)(c), (d), or (e);
6. A photograph of the applicant
taken not more than six months before the date of application; and
7. The fee required in
R4-20-112.
