HAR §16-83-12. Forms and instructions

(a) An application for license or permit shall be made under oath on forms provided by the board and shall not be considered complete unless accompanied with the required documentation and fees. It shall be each applicant’s responsibility to furnish all information and any documentation requested by the board. (b) The application form may require the applicant to provide the following: 83-5 §16-83-12 (1) The applicant’s full name; (2) A statement that the applicant has attained the age of majority; (3) The applicant’s current business or mailing address for publication, and the applicant’s current residence address; (4) The applicant’s social security number; (5) The applicant’s educational history and evidence of the education; (6) The date and place of any conviction of a crime in which a jail sentence was imposed, unless the conviction has been expunged or annulled or is otherwise precluded from consideration by section 831-3.1, HRS; (7) The state(s) or jurisdiction(s) in which the applicant is currently licensed, and any information regarding any disciplinary proceedings or disciplinary actions taken by any state or jurisdiction against the license; (8) A statement that the applicant is a United States citizen or an alien authorized to work in the United States; (9) The name, license number, and place of business of the hearing aid dealer and fitter who will be supervising the training of a person issued a temporary permit; (10) The applicant’s intended business address either as an employee or an owner of the business; and (11) Any other information the board may require to investigate the applicant’s qualifications for license or permit. (c) Any requirement that the board provide notice to licensees or permittees shall be deemed met if notice is sent to the address on file with the board. (d) Any change in the application or of any information filed with the board shall be reported to the board, in writing, within thirty days of the change. [Eff 11/22/82; comp 8/8/86; am and comp 7/18/94] (Auth: HRS §451A-5) (Imp: HRS §§451A-2, 451A-5, 451A-7, 451A-9, 451A-10, 451A-11, 436B-10, 436B-11)