Physician assistants: Application for license.

1. An application for a license as a physician assistant must include, without limitation: (a) The date and place of birth of the applicant; (b) The gender of the applicant; (c) The education of the applicant, including, without limitation, any high school and postsecondary institution attended, the length of time in attendance and whether the applicant is a graduate of those schools and institutions; (d) The training and experience of the applicant as a physician assistant; (e) Whether the applicant has ever: (1) Applied for a license or certificate as a physician assistant in another state and, if so, specification of which state, when the application was made and the results of the application; (2) Had a license or certificate as a physician assistant revoked, modified, limited or suspended; (3) Been investigated for misconduct as a physician assistant; (4) Had any disciplinary action or proceeding instituted against him or her by a licensing body in any jurisdiction; (5) Been convicted of a felony or an offense involving moral turpitude; or (6) Been investigated for, charged with or convicted of the use or illegal sale or dispensing of a controlled substance; and (f) The places of residence of the applicant since the date of his or her graduation from high school or his or her receipt of a high school general equivalency diploma. 2. An application for a license as a physician assistant must be: (a) Signed by the applicant; (b) Sworn to before a notary public or other officer authorized to administer oaths; and (c) Accompanied by: (1) An official transcript from any postsecondary educational institution or any educational program for physician assistants, as described in paragraph (c) of subsection 1 of NAC 633.281 , attended by the applicant; (2) A notarized copy of the applicant’s passport, a certified copy of the applicant’s birth certificate, naturalization papers or such other documentation regarding United States citizenship that is satisfactory to the Board or a copy of documentation evidencing the lawful entitlement of the applicant to remain and work in the United States that is satisfactory to the Board; (3) Proof of certification by the National Commission on Certification of Physician Assistants; (4) An affidavit affirming that: (I) The applicant is the person named in the application and accompanying material; and (II) To the best knowledge or belief of the applicant, the application and all accompanying material is complete, correct and consistent, and was obtained without fraud, misrepresentation or mistake; and (5) The nonrefundable application and initial license fee prescribed in NAC 633.335 . 3. If it appears to the Board that: (a) Any information submitted is false or inconsistent; or (b) The application is not made in proper form or other deficiencies appear in it, Ê the application will be rejected.