Haw. Code R. § 16-85-72 - Application
(a) An application for license shall be made
under oath on a form to be provided by the board. The form shall require the
applicant to provide;
(1) The applicant's
full name;
(2) All applicable fees,
including the application fee which shall not be refunded;
(3) Evidence that the applicant is a graduate
in podiatric medicine from a college approved by the Council on Podiatric
Medical Education of the American Podiatric Medical Association;
(4) Evidence of passage of all parts of the
National Board of Podiatric Medical Examination (NB) and the Podiatric Medical
Licensing Examination for States (PMLEXIS);
(5) A report from the Federation of Podiatric
Medical Boards relating to public action records;
(6) Information regarding any conviction of
any crime which has not been annulled or expunged;
(7) If applicable, evidence of any licenses
held or once held in other jurisdictions indicating the status of the license
and documenting any disciplinary action; and
(8) Any other information the board may
require to investigate the applicant's qualifications for license.
(b) It shall be the applicant's
responsibility to furnish any information and documentation requested by the
board. In the event of any change of information provided, the applicant shall
notify the board of any change of information within thirty days of any
change.
(c) Every application and
all references shall be signed by the applicant or the person attesting to the
applicant's education, experience, and reputation.
Notes
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