Arizona Administrative Code
Title 4 - PROFESSIONS AND OCCUPATIONS
Chapter 45 - Board of Respiratory Care Examiners
Article 2 - LICENSURE
Section R4-45-201 - Application

Universal Citation: AZ Admin Code R 4-45-201

Current through Register Vol. 30, No. 38, September 20, 2024

A.In addition to meeting the qualifications listed in A.R.S. § 32-3523(A), an applicant for a license to practice as a respiratory care practitioner shall submit the following information on the Board's license application form:

1. The applicant's full name and Social Security number;

2. The applicant's current mailing, permanent and e-mail addresses;

3. The applicant's current employer's name, address, and telephone number;

4. The applicant's current employment position and beginning date of employment;

5. The applicant's current supervisor's name and telephone number;

6. The applicant's area of care or specialty;

7. The applicant's birth date;

8. The applicant's home and work telephone numbers;

9. Any name by which the applicant has ever been known. The applicant shall submit documentation of name change if the applicant is applying for licensure under a name different from that on the applicant's credentials, educational degree, or diploma;

10. A statement of the facts entitling the applicant to take the RRT examination, to receive a license without examination under R4-45-206;

11. The name of any state or province in which the applicant has been granted a certification, registration, or license as a respiratory care practitioner; including the number, date issued, expiration date, and a statement whether that certificate, registration, or license has ever been the subject of discipline, censure, probation, practice restriction, suspension, revocation, or cancellation;

12. A statement whether the applicant has ever been denied a professional license or certificate or the privilege of taking an examination by a governing licensing authority and, if the answer is yes, a complete explanation of the denial including date, state or province, and a copy of any order issued;

13. A statement whether the applicant is the subject of any pending disciplinary action that is directly or indirectly related to the practice of respiratory therapy and, if the answer is yes, a complete explanation, including date, state or province, and a copy of any order issued;

14. A statement whether the applicant has ever voluntarily surrendered a professional license and, if the answer is yes, a complete explanation, including dates, state or province, and a copy of any order issued;

15. A statement whether the applicant has ever filed an application for a respiratory care practitioner license in Arizona and, if the answer is yes, the date;

16. A statement whether the applicant has been enrolled in or committed to a substance-abuse or alcohol-treatment program in the past 10 years and, if the answer is yes, a complete explanation, including date, place, and a copy of any documentation of completion of the program;

17. Except for a minor traffic violation, a statement whether the applicant has ever been convicted of, pled no contest (nolo contendere) to, entered into any agreement concerning an arrest or charge (even if the agreement resulted in a dismissal or expungement of record), or has an outstanding arrest or charge for any violation of any law of any state of the United States, or a foreign country and, if the answer is yes, a complete explanation, including place, date, and a copy of any pertinent documentation such as a court order or plea agreement;

18. A statement whether the applicant has had an intemperance to drugs or alcohol within the last 10 years and, if the answer is yes, a complete explanation;

19. The applicant's physical description, including height, weight, and eye and hair color;

20. The highest level of education completed by the applicant;

21. Evidence of the applicant's U.S. citizenship, alien status, legal residency, or lawful presence in the U.S.;

22. Consistent with the Board's authority under A.R.S. § 32-3522(B)(4), other information or documentation the Board determines is necessary to evaluate the applicant fully;

23. A record or documentation release; and

24. The applicant's certification that the information provided is true and complete and that the applicant has not engaged in any act prohibited by Arizona law or this Chapter.

B. An applicant shall submit or have submitted on the applicant's behalf the following with the license application form:

1. If NBRC- registered, a copy of the applicant's:
a. NBRC-issued registration;

b. RRT examination results; or

c. If grandfathered, CRT examination results.

2. If not NBRC-certified or registered, a copy of the applicant's diploma awarded upon successful completion of an approved respiratory therapy training program or letter of completion from the registrar of an approved respiratory therapy training program that provides the date of the applicant's successful completion;

3. If ever licensed as a respiratory care practitioner in another state, the information specified in R4-45-205;

4. If foreign-trained, the information specified in R4-45-204;

5. The fee required under R4-45-102(A)(1); and

6. A full set of fingerprints submitted on a card provided by the Board for a state and federal criminal background check along with the fee prescribed at R4-45-102(A)(10).

C. An applicant shall inform the Board in writing of a change in the applicant's address or other contact information within 10 days from the date of the change.

D. An applicant shall inform the Board immediately, by fax or e-mail, of the following:

1. A change in any non-contact information provided on the license application,

2. A change in the applicant's employment status and the reason for the change, or

3. Other information that a reasonable person would believe is relevant to the Board's decision to grant or deny a license to the applicant.

Disclaimer: These regulations may not be the most recent version. Arizona may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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