Get Licensure Application For Assembly Testing Technician - Healthy Arkansas

Filling out the Licensure Application for Assembly Testing Technician with the Arkansas Department of Health is a straightforward process. This guide provides clear, step-by-step instructions to help you complete the application smoothly and accurately.

Follow the steps to successfully fill out your application online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your name in the designated fields: first name, middle name, and last name.
3. Next, fill in your current address along with your ZIP code in the respective section.
4. Provide your date of birth and Social Security number in the indicated fields.
5. Enter your phone numbers in the home and business sections to ensure contact availability.
6. Respond to the question regarding whether you hold an occupational license, and if applicable, indicate the state of issue.
7. Specify the type of license you possess by providing the relevant details in the designated spaces.
8. Indicate whether you have attended a backflow school and, if yes, ensure to attach proof of this attendance.
9. In the next section, provide the name and address of the backflow school you attended, along with the dates.
10. Affirm the truthfulness of your responses by signing in the appropriate area, and have the application notarized.
11. Finally, review all your entries for correctness before you finalize the application. You can save changes, download, or print the form for submission.

Complete your application online today to ensure a smooth licensure process!