Applications for examination: Requirements. [Effective on the date of the repeal of the federal law requiring each state to establish procedures for withholding, suspending and restricting the professional, occupational and recreational licenses for child support arrearages and for noncompliance with certain processes relating to paternity or child support proceedings.]
1. An applicant for examination must file an application not less than 60 days before the date of the examination.
2. An application must be filed with the Secretary of the Board on a form to be furnished by the Secretary.
3. An application must be verified and must state:
(a) When and where the applicant was born, the various places of his residence during the 5 years immediately preceding the making of the application and the address to which he wishes the department to mail his license.
(b) The name, age and sex of the applicant.
(c) The names and post office addresses of all persons by whom the applicant has been employed for a period of 5 years immediately preceding the making of the application.
(d) Whether or not the applicant has ever applied for a license to practice chiropractic in any other state and, if so, when and where and the results of the application.
(e) Whether the applicant is a citizen of the United States or lawfully entitled to remain and work in the United States.
(f) Whether or not the applicant has ever been admitted to the practice of chiropractic in any other state and, if so, whether any discharge, dismissal, disciplinary or other similar proceedings have ever been instituted against him. Such an applicant must also attach a certificate of the Secretary of the chiropractic board of the state in which the applicant was last licensed, certifying that the applicant is a member in good standing of the chiropractic profession in that state, and that no proceedings affecting his standing as a chiropractor are undisposed of and pending.
(g) The applicant’s general and chiropractic education, including the schools attended and the time of attendance at each school, and whether he is a graduate of any school or schools.
(h) The names of:
(1) Two persons who have known the applicant for at least 3 years; and
(2) A person who is a chiropractor licensed pursuant to the provisions of this chapter or a professor at a school of chiropractic.
Last modified: February 27, 2006