Section R8-2-703. Required Registration Information

The following information is the minimum information required to register as an emergency worker:

1.        Full name;

2.        Birth date;

3.        Gender;

4.        Social Security Number;

5.        Citizenship, to include a document verifying citizenship;

6.        Provide verification of eligibility to work in the United States;

7.        Address;

8.        Contact phone number and e-mail address;

9.        Driver’s  license  number,  issuing  state  and  expiration date;

10.     Registering jurisdiction;

11.     Registering agency/organization;

12.     Employer name, address and phone number;

13.     Personal reference name, address and phone number;

14.     Emergency contact name, address and phone number;

15.     Professional licenses, certificates and registrations, to include numbers and expiration dates (copies will be pro- vided);

16.     Court record of felony convictions;

17.     Record of misdemeanor convictions involving moral tur- pitude; and

18.     Medical conditions which may limit ability to perform as an emergency worker.

Historical Note

Section made by final rulemaking at 14 A.A.R. 4519, effective January 31, 2009 (Supp. 08-4)