Form Dop - Apprentice Registration - Alaska Department Of Community And Economic Development Page 2

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STATE OF ALASKA
DEPARTMENT OF COMMUNITY AND ECONOMIC DEVELOPMENT
DIVISION OF OCCUPATIONAL LICENSING
ALASKA STATE BOARD OF DISPENSING OPTICIANS
P.O. BOX 110806
JUNEAU, ALASKA 99811-0806
(907) 465-5470
E-mail: license@dced.state.ak.us
STATEMENT OF RESPONSIBILITY
(To be completed by supervisor)
Date:
I,
, am willing to assume the full
Name of Sponsor
responsibility of apprenticing
, in practice of
Name of Apprentice
q
q
Dispensing Opticianry:
Spectacles
Contact Lenses.
Laws governing apprentice training and apprenticeship registration are as follows:
Sec. 08.71.240. Definitions.
(4) “dispensing optician” means a person who, on written prescription from a licensed physician or optometrist, prepares and
dispenses to the intended wearer or person who writes the prescription, original or duplicate lenses, eyeglasses, contact lenses, and
appurtenances to them, and interprets, measures, adapts, fits, and adjusts lenses, eyeglasses, contact lenses, and appurtenances
to them in accordance with the written prescription, to the face for the aid or correction of visual or ocular anomalies of the human eye;
(5) “supervision” means the provision of any needed direction, control, consultation, instruction, evaluation, and personal inspection
of work being performed.
12 AAC 30.110. APPRENTICESHIP REGISTRATION. (a) To register an apprentice, the supervisor must complete and return a registration
form provided by the department and pay the fee established in 12 AAC 02.200(1).
(b) Except under (c) of this section, no hours of apprenticeship training received before registration will be accepted under
AS 08.71.110(a)(2)(A).
(c) The board will, in its discretion, accept under AS 08.71.110(a)(2)(A), apprenticeship training hours received before registration when
those hours are documented at the time of initial registration and are verified by the department, only in those cases when an applicant
received training out of state before beginning an apprenticeship in Alaska.
(d) The supervisor of an apprentice shall notify the board of the termination of an apprenticeship or a change in supervisors.
12 AAC 30.990
(4) “apprentice” means a novice in the field of opticianry who has not previously been licensed in the field, but who is working
towards completion of the 6,000 hours of training required by AS 08.71.110 under the direct supervision of a licensed dispensing
optician, optometrist, or ophthalmologist;
(5) “direct supervision” means that the licensed supervisor is physically present at the same site as the apprentice while dispensing
optician tasks are being performed by the apprentice under the supervision of the supervisor.
Sec. 08.71.160. Dispensing optician’s apprentice. (a) A person may be employed by or serve under a licensed dispensing optician
as an apprentice. An apprentice shall register with the department before beginning employment or service as an apprentice, shall be
designated as such in the records of the board, and shall be in training and under the direct supervision of a licensed physician,
optometrist, or dispensing optician. Under this section, a person may not apprentice for longer than six years unless the board
determines that the person is prevented by circumstances beyond the person’s control from obtaining a license as a dispensing optician
within that time.
(b) No more than two apprentices may be under the direct supervision of one licensed dispensing optician at the same time.
q
q
I am currently licensed as a
,
Spectacles
Contacts
in the State of Alaska, License Number
Expiration Date:
I certify under penalty of perjury that the above information is true and correct, and that I have read the above laws and agree to comply
with these laws.
Signature
SUBSCRIBED AND SWORN to before me this
day of
, 20
at
City
State
SEAL
Notary Public
My Commission Expires:
08-4002a (Rev. 7/00)

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