Get Az Adhs Certified Practical Technologist In Radiology Initial Application 2019

Filling out the Arizona Department of Health Services Certified Practical Technologist In Radiology Initial Application online is a crucial step in beginning your journey in this field. This guide provides step-by-step instructions to ensure that you complete the application accurately and efficiently.

Follow the steps to successfully complete your online application.

1. Click ‘Get Form’ button to obtain the form and open it in the appropriate format.
2. Enter your legal first name, middle name, and last name in the designated fields.
3. If applicable, include your previous Arizona CPTR number.
4. Fill out your date of birth, social security number, email address, and phone number.
5. Provide your residential street address, including apartment or unit number, city, state, and zip code.
6. If your mailing address differs from your residential address, enter that information as well.
7. Complete the license/certification history section, including any current certifications and their numbers.
8. If you have held a Medical Radiologic Technology certificate in Arizona before, provide the certificate number(s) and expiration date(s).
9. Fill out the educational information, including the name of the institution, degree or certification obtained, address, and date of graduation.
10. In the employment section, state whether you are currently employed and provide details about your current or most recent employer.
11. Address any criminal history, providing details of any convictions, including date, court name, and disposition.
12. Complete the attestation section, ensuring all entered information is true and accurate.
13. Review your application checklist to ensure all required documentation is attached.
14. Once all fields are complete, save your changes, and you may either download, print, or share the completed form.

Complete your application online today and take the next step in your professional journey.