Follow the steps to successfully complete your application online.

1. Click ‘Get Form’ button to obtain the form and open it in an editing tool.
2. Begin by providing your legal first, middle, and last name in the designated fields. Make sure that the names match those on your identification documents for consistency.
3. Enter your date of birth formatted as MM/DD/YYYY. This is essential for verifying your identity.
4. Fill in your Social Security Number, ensuring that it follows the required format of XXX-XX-XXXX.
5. Add your email address and phone number in the respective fields to allow for communication regarding your application.
6. Complete the residential and mailing address sections accurately, noting whether the mailing address is different from your residential address.
7. If applicable, provide details about your license or certification history, including the names of any professional certifications you hold and the states that issued them.
8. Disclose any past disciplinary actions taken against your professional license. If you have experienced such actions, provide details as prompted on the form.
9. Fill in your educational background, including the name of the institution, the degree or certification obtained, and the date of graduation.
10. Complete the employment section by specifying your current or most recent employer, position held, and dates of employment.
11. Declare any criminal history by indicating whether you have ever been convicted of a crime. If so, provide the requested details.
12. Review all completed sections of the form to ensure accuracy. Missing items or incomplete fields may delay processing.
13. Finally, sign the application certifying that all information is true and accurate, and date it accordingly.
14. Save your changes, and download or print the completed application for your records. Be sure to share or submit the application as required.

Complete your AZ ADHS Certified Practical Technologist in Radiology Initial Application online today!