Each applicant for license renewal shall provide, or cause to be provided, the following on a renewal form supplied by the board:

1. (a) The applicant’s full name;
2. (b) The applicant’s business address and telephone number;
3. (c) The applicant’s home address and telephone number;
4. (d) Documentation that the applicant has complied with the continuing education requirements of Lan 402;
5. (e) A statement fully describing any disciplinary or legal action brought against the applicant for his or her services as a land surveyor;
6. (f) A statement indicating whether the applicant has adhered to the ethical and professional standards of Lan 500;
7. (g) A representation that the applicant acknowledges that the provision of false information recklessly provided in the application is a basis for disciplinary action by the board; and
8. (h) The applicant’s signature and date.

Source. #3030, eff 5-28-85; ss by #5555, eff 1-15-93; ss by #5934, eff 12-9-94, EXPIRED: 12-9-00 New. #7425, INTERIM, eff 1-13-01, EXPIRED: 7-12-01 New. #7549, eff 8-25-01; ss by #9340, eff 1-1-09; ss by #12031, eff 11-1-16