Current through Register Vol. 30, No. 38, September 20, 2024
Except as provided in
R9-17-107(F)
or
R9-17-324(C),
to obtain a dispensary agent registry identification card for an individual
serving as a principal officer or board member for the dispensary, employed by
the dispensary, or providing volunteer services at or on behalf of the
dispensary, the dispensary shall submit to the Department the following for
each individual:
1. An application in
a Department-provided format that includes:
a.
The individual's first name; middle initial, if applicable; last name; and
suffix, if applicable;
b. The
individual's residence address and Arizona mailing address;
c. The county where the individual
resides;
d. The individual's date
of birth;
e. The identifying number
on the applicable card or document in subsection (4)(a) through (e);
f. The name and registry identification
number of the dispensary; and
g.
The signature of the individual in
R9-17-304(C)(1)(d)
or of a principal officer or board member, as applicable, designated to submit
dispensary agent applications on the dispensary's behalf and the date
signed;
2. An
attestation signed and dated by the individual that the individual:
a. Has not been convicted of an excluded
felony offense as defined in A.R.S. §
36-2801,
or
b. Is deemed to not have been
convicted of an excluded felony offence through holding a valid level I
fingerprint clearance card issued according to A.R.S. §
41-1758.07;
3. A
statement in a Department-provided format signed by the individual pledging not
to divert marijuana to any other individual who or entity that is not allowed
to possess marijuana pursuant to A.R.S. Title 36, Chapter 28.1;
4. A
copy of the individual's:
a. Arizona driver's
license issued on or after October 1, 1996;
b. Arizona identification card issued on or
after October 1, 1996;
c. Arizona
registry identification card;
d.
Photograph page in the individual's U.S. passport or a U.S. passport card;
or
e. Arizona driver's license or
identification card issued before October 1, 1996 and one of the following for
the individual:
i. Birth certificate verifying
U.S. citizenship,
ii. U.S.
Certificate of Naturalization, or
iii. U.S. Certificate of
Citizenship;
5. A current photograph
of the individual;
6. For the Department's criminal records check
authorized in A.R.S. §§
36-2804.01
and
36-2804.05:
a. The individual's fingerprints on a
fingerprint card that includes:
i. The
individual's first name; middle initial, if applicable; and last
name;
ii. The individual's
signature;
iii. If different from
the individual, the signature of another individual physically rolling the
individual's fingerprints;
iv. The
individual's address;
v. If
applicable, the individual's surname before marriage and any names previously
used by the individual;
vi. The
individual's date of birth;
vii.
The individual's Social Security number;
viii. The individual's citizenship
status;
ix. The individual's
gender;
x. The individual's
race;
xi. The individual's
height;
xii. The individual's
weight;
xiii. The individual's hair
color;
xiv. The individual's eye
color; and
xv. The individual's
place of birth;
b. If the
individual's fingerprints and information required in subsection (6)(a) were
submitted to the Department as part of an application for a designated
caregiver registry identification card, dispensary agent registry
identification card for another dispensary, or laboratory agent registry
identification card within the previous six months, the registry identification
number on the registry identification card issued to the individual as a result
of the application; or
c.
Documentation that the individual has a valid level I fingerprint clearance
card issued according to A.R.S. §
41-1758.07;
and
7. The applicable fee
in
R9-17-102 for applying for a
dispensary agent registry identification card.
