Section R4-12-202. Application for an Intern, an Embalmer, or a Funeral Director License

A.      An applicant for an intern, an embalmer, or a funeral director license shall submit an application packet to the Board that contains the information required in A.R.S. § 32-1323, and the following:

1.        An application form provided by the Board, signed and dated by the applicant, and notarized that contains:

a.         The applicant’s name, mailing address, telephone number, and social security number;

b.        The applicant’s date and place of birth;

c.         Any prior name or alias of the applicant;

d.        The name and address of the high school from which the applicant graduated and the graduation date or date applicant received a general equivalency diploma;

e.         The name and address of the mortuary school from which the applicant graduated and graduation date;

f.         The name, address, and telephone number of the funeral establishment employing the applicant;

g.        Whether the applicant has ever been convicted of or entered into a plea of no contest to a class 1 or 2 fel- ony, including the information in subsection (A)(1)(h)(i) through (A)(1)(h)(vi);

h.        Whether the applicant, within five years from the date of the application, has been convicted of or entered into a plea of no contest to a felony or to a misdemeanor that is reasonably related to the appli- cant’s proposed area of licensure including the:

i.         Charged felony or misdemeanor;

ii.        Date of conviction;

	iii.   Court having  jurisdiction over  the felony  or		ii.     The state in which the apprenticeship or intern-
	misdemeanor;		ship was served,
	iv.   Probation   officer’s  name,  address,  and   tele-		iii.   The applicant’s state registration number and
	phone number, if applicable;		date of issuance, and
	v.     A copy of the notice of expungement, if appli-		iv.   The number of human bodies embalmed by the
	cable; and		applicant during the apprenticeship or intern-
	vi.   A  copy  of  the  notice  of  restoration   of  civil		ship;
	rights, if applicable;	c.	The following information:
i.	Whether the applicant, within five years from the		i.      The name of each state in which the applicant
	date  of  the  application,   has  committed  any  act		has been licensed or registered as an embalmer
	involving   dishonesty,    fraud,   misrepresentation,		or funeral director,
	breach of fiduciary duty, gross negligence, or incom-		ii.     The date of issuance of each funeral director or
	petence reasonably related to the applicant’s pro-		embalmer license or registration, and
	posed area of licensure;		iii.   The license or registration number in each state
j.	Whether the applicant is currently incarcerated or on		in which the applicant is or has been licensed or
	community supervision after a period of imprison-		registered as an embalmer or funeral director;
	ment in a local, state, or federal penal institution or	d.	The name of each mortuary at which the applicant
	on criminal probation;		practiced as an embalmer or funeral director for five
k.	Whether the applicant, within five years from the		years  immediately   before  the   application  date,
	date of the application, has had an application for a		beginning and ending dates of the practice, and a
	license,  registration,   certificate,  or  endorsement		description of the practice, if applicable;
	denied or  rejected  by  any  state  funeral  licensing	e.	A  notarized  statement  from  a  funeral  director
	authority including the:		licensed or registered in any state that contains the
	i.      Reason for the denial or rejection,		funeral director’s:
	ii.     Date of the denial or rejection, and		i.      State in which licensed;
	iii.   Name and address of the agency that denied or		ii.     License number and issuance date;
	rejected the application;		iii.   Statement of length of  time that the funeral
l.	Whether the applicant has, within five years from		director has known the applicant;
	the date of the application, had a license, registra-		iv.   Statement   attesting  to   the  applicant’s   good
	tion,   certificate,   or   endorsement   suspended   or		character, reputation, and professional ability;
	revoked  by  any  state  funeral   licensing  authority		and
	including the:		v.     Recommendation for the Board’s approval of
	i.      Reason for the suspension or revocation,		the applicant; and

ii.        Date of the suspension or revocation, and

iii.      Name and address of the state licensing author- ity that suspended or revoked the license;

m.       Whether the applicant has ever surrendered a license, registration, certificate, or endorsement to the Board or any state funeral licensing authority;

n.        The dates the applicant served as an apprentice embalmer or intern, location of apprenticeship or internship, and the number of human bodies embalmed, if applicable;

o.        A statement of whether the applicant has passed a national board examination or state equivalent examination, if applicable; and

p.        A notarized statement by the applicant verifying the information on the application is true and correct;

2.        A copy of the applicant’s high school or general equiva- lency diploma;

3.        A copy of  the transcript from  each mortuary college attended by the applicant and, if applicable, each diploma issued to the applicant; and

4.        The fee required by the Board.

B.       In addition to the requirements in subsection (A), an applicant for an intern license shall submit on the application form the name and license number of the embalmer who will supervise the applicant.

C.      In addition to the requirements in subsection (A), an applicant for an embalmer license shall submit to the Board:

1.        On the application form:

a.         Whether the applicant has embalmed 25 or more human bodies;

b.        Apprenticeship or internship information including:

i.         Beginning and ending dates,

2.        A report of apprenticeship or internship containing:

a.         The applicant’s name,

b.        The name of the funeral establishment in which the apprenticeship or internship was served,

c.         The name of the embalmer supervising the appli- cant,

d.        The   beginning  and  ending   dates  covered  in   the report,

e.         The number of hours worked each month during the apprenticeship or internship,

f.         The number of human bodies embalmed each month during the apprenticeship or internship, and

g.        For each human body embalmed:

i.         The name of the deceased,

ii.        The date of death,

iii.      A statement of whether an autopsy was per- formed, and

iv.       The  supervising  embalmer’s  signature   and license number,

D.      In addition to the requirements in subsection (A), an applicant for a funeral director license shall submit to the Board a report containing:

1.        The applicant’s name;

2.        The name of the funeral establishment in which one year of funeral directing experience was obtained;

3.        The name of the responsible funeral director;

4.        The beginning and ending dates covered in the report; and

5.        For each burial, immediate burial, or direct cremation conducted by the applicant:

a.         The name of the deceased;

b.        The date of the burial, immediate burial, or direct cremation;

c.         A statement of whether the applicant conducted a burial, immediate burial, or direct cremation; and

d.        The supervising funeral director’s signature and license number.

E.       In addition to the requirements in subsection (A), an applicant for an embalmer or funeral director license who holds an out- of-state embalmer or funeral director license shall:

1.        Submit on the application form, the name of each state in which the applicant is licensed or registered as an embalmer or funeral director; and

2.        Arrange for the out-of-state licensing authority to com- plete the following on the application form to be submit- ted with the application packet:

a.         Certification of current licensure of the applicant;

b.        Type of license, license number, and date license was issued;

c.         A statement of whether the applicant qualified by examination or by being licensed by another state;

d.        A statement of whether the licensing authority has ever suspended, revoked, or taken any other action against the applicant’s license; and

e.         Notarized signature and title of agency official;

F.       An applicant for a multiple funeral director license shall sub- mit an application form that is signed and dated by the appli- cant, and notarized that includes the information in subsections (A)(1)(a) through (A)(1)(c) and:

1.        The name and address of the funeral establishment for which the applicant:

a.         Currently acts as the responsible funeral director, and

b.        Is applying to act as the responsible funeral director;

2.        The distance, stated in miles, between the current funeral establishment and the funeral establishment for which application is being made;

3.        For the funeral establishment for which application is being made and for 12 months immediately preceding the application, the number of:

a.         Funerals and cremations conducted at the funeral establishment, and

b.        Transportations of human remains arranged through the funeral establishment;

4.        The fee required by the Board; and

5.        Other information required by the Board.

Historical Note

Adopted effective September 18, 1987 (Supp. 87-3). Section repealed; new Section adopted by final rulemaking at 7 A.A.R. 1441, effective March 14, 2001

(Supp. 01-1).