R9-17-311. Submitting an Application for a Dispensary Agent Registry Identification Card

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.