Section R4-11-901. Application for Restricted Permit

A.      An applicant for a restricted permit shall provide the following information and documentation on a form provided by the Board:

1.        A sworn statement of the applicant’s qualifications for a restricted permit;

2.        A photograph of the applicant that is no more than six months old;

3.        A letter of endorsement from any other jurisdiction in which an applicant is licensed, sent directly from that jurisdiction to the Board;

4.        A letter of endorsement from the applicant’s commanding officer or superior if the applicant is in the military or employed by the United States government;

5.        A copy of the applicant’s current cardiopulmonary resus- citation certification that meets the requirements of R4- 11-301(A)(6); and

6.        A copy of the applicant’s pending contract with a charita- ble dental clinic or organization offering dental or dental hygiene services.

B.       The Board may request that an applicant provide a copy of a certified document that indicates the reason for a name change if the applicant’s application contains different names.

Historical Note

Adopted effective September 7, 1979 (Supp. 79-5). For- mer Section R4-11-130 renumbered as Section R4-11- 901, repealed, and new Section R4-11-901 adopted effec- tive July 29, 1981 (Supp. 81-4). Amended effective April

4, 1986 (Supp. 86-2). Emergency amendment adopted

effective June 18, 1991, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 91-2). Emergency expired. Adopted effective July 13, 1992 (Supp. 92-3). Former Section R4-11-901 renumbered to R4-11-401, new Sec- tion R4-11-901 renumbered from R4-11-1001 and amended by final rulemaking at 5 A.A.R. 580, effective February 4, 1999 (Supp. 99-1). Section amended by final

rulemaking at 11 A.A.R. 793, effective April 2, 2005

(Supp. 05-1).