1. (a) Applications must be on a form provided by the department which will require furnishing of the following information:

   1. (1) full name;
   2. (2) residence address;
   3. (3) social security number;
   4. (4) residence telephone number;
   5. (5) present or prospective employer and address;
   6. (6) age;
   7. (7) sex;
   8. (8) date of birth;
   9. (9) place of birth;
   10. (10) height and weight;
   11. (11) hair and eye color;
   12. (12) residence addresses for the past five years;
   13. (13) employment for the past five years;
   14. (14) three character references;
   15. (15) military discharge record, if any;
   16. (16) criminal arrest and conviction record;
   17. (17) an affirmation that the applicant is neither addicted to nor dependent on alcohol, narcotics, or other drugs;
   18. (18) an affirmation that the applicant is not suffering from any psychopathic condition or mental illness impairing the powers of memory, reason, judgment, or perception.
2. (b) The application must be signed by the applicant and the signature must be notarized.

3. (c) The following items must also accompany the application:

   1. (1) one frontal view photograph of the applicant; the photograph must

      1. (A) include the upper part of the body from the waist up;
      2. (B) have been taken within the 30 days before submission; and
      3. (C) be of a size, color, and condition that will allow the photograph to be processed in the department's identification production equipment;
   2. (2) two sets of classifiable fingerprints;
   3. (3) proof of bonding or insurance; and
   4. (4) a non-refundable application fee of $50 and the fees required for fingerprint processing under 13 AAC 68.900.
4. (d) Repealed 12/21/2002.
5. (e) If the applicant has been hired on a temporary basis pending issuance of license, as provided by 13 AAC 60.130, it must be so noted on the application by the agency manager.

(Eff. 5/29/77, Register 62; am 10/2/92, Register 123; am 12/21/2002, Register 164)

Authority: AS 18.65.410, AS 18.65.420, AS 18.65.450, AS 18.65.470