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          20:61:01:03.  Required contents of applications. All applications for licensure shall contain the following:

          (1)  An affidavit, with a photograph of the applicant attached, attesting to the applicant's qualifications required by SDCL 36-4B and this chapter;

          (2)  A certificate of good moral character signed by two persons licensed to engage in any branch of the healing arts including therapy and nursing, whether issued by the board, a similar board in another state or the District of Columbia, or the recognized national board, neither of whom shall at the time of making the certificate be under any charge or accusation which would be grounds for cancellation, suspension, or revocation of the person's license. Such persons shall verify that they are personally acquainted with the applicant and know of the applicant's moral character;

          (3)  A list of all states in which the applicant is or has at any time been licensed to perform any type of life support service;

          (4)  A statement of all places where the applicant has previously provided life support services;

          (5)  A statement of whether the applicant has ever been convicted of any criminal offense; and

          (6)  A history of all schooling relating to life support services, with dates and places, credit or degrees earned, and average grades received.

          Source: 5 SDR 68, effective February 15, 1979; 12 SDR 151, 12 SDR 155, effective July 1, 1986.

          General Authority:SDCL 36-4B-35.

          Law Implemented:SDCL 36-4B-13.

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