340.316. 1. The application shall include the disclosureof:
(1) Applicant's full name;
(2) Place of employment;
(3) Supervisor's name, license number and signature;
(4) Business and residence addresses;
(5) Date and number of applicant's certificate;
(6) Any disciplinary actions taken against the applicant byany state, territory or district of the United States or federalagency;
(7) Felony criminal convictions;
(8) Continuing educational credits; and
(9) Other information deemed necessary by the board toassess the applicant's fitness for certificate renewal.
2. The application shall be made under oath or affirmationby the applicant. The applicant is subject to penalties providedfor under the laws of this state for making a false statementunder an oath or affirmation, which shall be in addition to andnot in lieu of any penalty or other discipline provided for bysections 340.200 to 340.330.
340.316. 1. The application shall include the disclosureof:
(1) Applicant's full name;
(2) Place of employment;
(3) Supervisor's name, license number and signature;
(4) Business and residence addresses;
(5) Date and number of applicant's certificate;
(6) Any disciplinary actions taken against the applicant byany state, territory or district of the United States or federalagency;
(7) Felony criminal convictions;
(8) Continuing educational credits; and
(9) Other information deemed necessary by the board toassess the applicant's fitness for certificate renewal.
2. The application shall be made under oath or affirmationby the applicant. The applicant is subject to penalties providedfor under the laws of this state for making a false statementunder an oath or affirmation, which shall be in addition to andnot in lieu of any penalty or other discipline provided for bysections 340.200 to 340.330.
340.316. 1. The application shall include the disclosureof:
(1) Applicant's full name;
(2) Place of employment;
(3) Supervisor's name, license number and signature;
(4) Business and residence addresses;
(5) Date and number of applicant's certificate;
(6) Any disciplinary actions taken against the applicant byany state, territory or district of the United States or federalagency;
(7) Felony criminal convictions;
(8) Continuing educational credits; and
(9) Other information deemed necessary by the board toassess the applicant's fitness for certificate renewal.
2. The application shall be made under oath or affirmationby the applicant. The applicant is subject to penalties providedfor under the laws of this state for making a false statementunder an oath or affirmation, which shall be in addition to andnot in lieu of any penalty or other discipline provided for bysections 340.200 to 340.330.
