21 NCAC 16B .0701. INSTRUCTOR'S LICENSE

(a)  An applicant for an instructor's license shall submit to the Board:

(1)           a completed, notarized application form provided by the Board at www.ncdentalboard.org.

(2)           the non-refundable instructor's licensure fee;

(3)           a photograph of the applicant, taken within six months prior to the date of the application, affixed to the application;

(4)           a signed release form and completed Fingerprint Record Card, and other form(s) required to perform a criminal history check at the time of the application. The form and card are available from the Board office;

(5)           a statement disclosing and explaining any disciplinary actions, investigations, malpractice claims, state or federal agency complaints, judgments, settlements, or criminal charges;

(6)           a statement disclosing and explaining periods within the last ten years of any voluntary or involuntary commitment to any hospital or treatment facility, observation, assessment, or treatment for substance abuse, with verification demonstrating that the applicant has complied with all provisions and terms of any county or state drug treatment program, or impaired dentists or other impaired professionals program; and

(7)           a current CPR card.

(b)  In addition to the requirements of Paragraph (a) of this Rule, an applicant for an instructor's license shall ensure the submission to the Board office of the following documents as a package, with each document in an unopened envelope sealed by the entity involved:

(1)           if the applicant is or has ever been employed as a dentist by or under contract with an agency or organization, a certification letter of the applicant's current status and disciplinary history from each agency or organization where the applicant is or has been employed or under contract;

(2)           a certificate of the applicant's licensure status from the dental regulatory authority or other occupational or professional regulatory authority and information regarding all disciplinary actions taken or investigations pending, from all licensing jurisdictions where the applicant holds or has ever held a dental license or other occupational or professional license;

(3)           a report from the National Practitioner Databank or its international equivalent, if applicable;

(4)           a report of any pending or final malpractice actions against the applicant, verified by the malpractice insurance carrier covering the applicant.  The applicant shall submit a letter of coverage history from all current and all previous malpractice insurance carriers covering the applicant; and

(5)           a certification letter from the dean or director that the applicant has met or been approved under the credentialing standards of a dental school or an academic medical center with which the person is to be affiliated, and certification that such school or medical center is accredited by the American Dental Association's Commission on Accreditation or the Joint Commission on Accreditation of Health Care Organizations.

(c)  All information required shall be completed and received by the Board office as a complete package with the initial application and application fee.  Incomplete applications shall be returned to the applicant.

(d)  Any applicant who changes his or her address shall notify the Board office within 10 business days.

(e)  Should the applicant reapply for an instructor's license, an additional instructor's license fee shall be required.

(f)  Any license obtained through fraud or by any false representation shall be void ab initio and of no effect.

(g)  The license shall be renewed on an annual basis, as set out in 21 NCAC 16R .0102.

 

History Note:        Authority G.S. 90-28; 90-29.5;

Temporary Adoption Eff. January 1, 2003;

Eff. January 1, 2004;

Recodified from 21 NCAC 16B .0601 Eff. March 1, 2006;

Amended Eff. September 1, 2014.