Form 08-4002 - Dispensing Optician Apprentice Registration Application printable pdf download

STATE OF ALASKA

DEPARTMENT OF COMMERCE, COMMUNITY, AND ECONOMIC DEVELOPMENT

DIVISION OF CORPORATIONS, BUSINESS AND PROFESSIONAL LICENSING

DISPENSING OPTICIANS SECTION

333 WILLOUGHBY AVENUE, 9TH FLOOR

P.O. BOX 110806

JUNEAU, AK 99811-0806

(907) 465-2543

E-mail: license@alaska.gov

DISPENSING OPTICIAN APPRENTICE REGISTRATION APPLICATION

Applicant MAY NOT receive credit for apprenticeship until the application is received by the Division of Corporations, Business

and Professional Licensing, and application is processed. NO HOURS EARNED IN ALASKA MAY BE CREDITED BEFORE

REGISTERING AS A DISPENSING OPTICIAN APPRENTICE. You may not practice in Alaska until licensed or registered.

If you are not licensed in another state but worked as a dispensing optician or worked as an apprentice in another state, you

must first register as an apprentice in Alaska.

The following must be submitted to the Division of Corporations, Business and Professional Licensing for approval in

the apprentice program:

Complete, notarized application on a form provided by the department.

Notarized Statement of Responsibility form provided by the department, completed by the licensed

instructor (supervisor) who must hold a current license in Alaska as a Dispensing Optician, Optometrist, or

Physician.

Mail completed forms along with the registration fee to the address above. You will receive written

confirmation of date of apprenticeship enrollment from the board office.

REQUIREMENTS

Please read the applicable statutes and regulations pertaining to apprenticeships. AS 08.71.160; AS 08.71.240; 12 AAC

30.110; and 12 AAC 30.900.

Before starting an apprenticeship, the apprentice shall register by submitting a form provided by the department. No hours of

apprentice training before registration will be counted toward the 1,800-hour requirement in AS 08.71.110. (a)(2)(A).

Documentation of any hours of apprentice training or employment as a dispensing optician outside Alaska must be verified on a

form provided by the department at the time of initial registration for review by the department.

“Regular Supervision” means that the licensed supervisor (1) is physically present at the same site as the person being

supervised at least once each day while dispensing optician tasks are being performed by the supervisee; (2) frequently

observes and reviews the supervisee’s performance of those tasks; (3) ensures that the supervisee performs all dispensing

opticians tasks correctly under the supervision of the supervisor; (4) is not away from the location where the supervision takes

place for more than two hours each day. No more than two apprentices may be under the supervision of one licensed

instructor/supervisor at the same time.

If the apprenticeship training is interrupted or discontinued, this office MUST be notified within 30 days to avoid a loss of training

hours. The apprentice must submit a new Statement of Responsibility form to register under a new sponsor. Training hours

under the new supervisor will not be accepted until the form and fees have been received by the department.

At the end of training or a change in supervisors, it is the apprentice’s responsibility to give the former sponsor a Verification of

Apprentice Training form for their completion, no hours will be considered by the department until the department office

receives this completed form. The department will review and notify the apprentice of approval in writing.

08-4002 (Rev. 05/04/11)

Form 08-4002 - Dispensing Optician Apprentice Registration Application