R4-12-206. Application

for a Prearranged Funeral Salesperson Registration An applicant for a prearranged funeral salesperson registration shall submit an application packet to the Board that contains the fee required by the Board, information required in A.R.S. § 32- 1391.14, and an application form that contains: 1. The applicant’s telephone number and social security number; 2. A statement of whether the applicant is a funeral director or embalmer licensed in Arizona; 3. Whether the applicant has ever been convicted of or entered into a plea of no contest to a felony or to a misdemeanor involving dishonesty, fraud, deception, misrepresentation, embezzlement, or breach of fiduciary duty in any state or federal court within seven years preceding the date of application including the: a. Charged felony or misdemeanor; b. Date of conviction; c. Court having jurisdiction over the felony or misdemeanor; d. Probation officer’s name, address, and telephone number, if applicable; e. A copy of the notice of expungement, if applicable; and f. A copy of the notice of restoration of civil rights, if applicable. 4. Whether the applicant, within seven years preceding the date of the application, has had an application for a license, registration, endorsement, or certificate denied or rejected by any state funeral licensing authority including the: a. Reason for the denial or rejection, b. Date of the denial or rejection, and c. Name and address of the agency that denied or rejected the application; 5. Whether the applicant, within seven years preceding the date of the application, has had a license, certificate, endorsement, or registration suspended or revoked by any state funeral licensing authority including the: a. Reason for the suspension or revocation, b. Date of the suspension or revocation, and c. Name and address of the agency that suspended or revoked the license; 6. A notarized statement signed by the applicant verifying the information on the application is true and correct; and 7. A notarized statement signed by the responsible funeral director verifying the applicant will be employed by the responsible funeral director upon issuance of the registration by the Board.