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(a) The board will issue a license by credentials to practice dental hygiene under this section to an applicant who meets the requirements of AS 08.32.030 and this section.
(b) An applicant for license under this section shall submit to the department
(1) a complete, notarized application on a form provided by the department;
(2) the applicable fees established in 12 AAC 02.190;
(3) an authorization from the applicant for release of the applicant's records to the department;
(4) an affidavit from the applicant that lists the license number and the name of the jurisdiction for all dental hygiene licenses that the applicant holds or has ever held in any jurisdiction.
(c) In addition to the requirements of (a) and (b) of this section, an applicant for a license under this section shall arrange for and ensure the submission of the results of a level II Professional Background Information Services (PBIS) credentials review conducted by PBIS, sent directly to the department from PBIS. The credential review must include
(1) a copy of a current certification in cardiopulmonary resuscitation (CPR) techniques for the applicant that meets the requirements of 12 AAC 28.920;
(2) a copy of the applicant's certificate of examination that meets the requirements of AS 08.32.020 (4);
(3) as required under 12 AAC 28.908(a) , a statement from the applicant certifying the applicant will adhere to the ethical standards specified in 12 AAC 28.905(a) ;
(4) an affidavit from the applicant stating for each of the two years immediately preceding application
(A) the dates and locations where the applicant has practiced dental hygiene;
(B) that the applicant has been in continuous active clinical practice averaging at least 14 hours per week for each of the two years immediately preceding application, as required under AS 08.32.020 (3);
(5) if the applicant is or has ever been employed as a dental hygienist with a federal agency, verification of the current status and disciplinary history from each federal agency where the applicant is or has been employed;
(6) verification of the applicant's status and complete information regarding any disciplinary action or investigation taken or pending from all licensing jurisdictions where the applicant holds or has ever held a dental hygiene license;
(7) affidavits from three licensed dentists or licensed dental hygienists stating the applicant has been in continuous active clinical practice averaging at least 14 hours per week for each of the two years immediately preceding application.
History: Eff. 1/22/2004, Register 169
Authority: AS 08.32.030
Editor's note: An application for a Professional Background Information Services (PBIS) credential review under 12 AAC 28.935 may be obtained from PBIS, 9201 North 25th Avenue, Suite 185, Phoenix, Arizona, 85021; telephone: (602) 861-5867.
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Last modified 7/05/2006