An applicant seeking dental therapist licensure shall submit to the department the following:

(1) Official transcripts verifying successful completion of a dental therapy education program approved by the commission.

(2) Official verification of passing the dental therapy examinations approved by the commission under WAC 246-819-050. Official verification must be sent directly to the department from the testing agency.

(3) An initial application on forms provided by the department.

(4) Written certification of any health professional licenses held, submitted directly from another licensing entity, and including license number, issue date, expiration date, and whether applicant has been the subject of final or pending disciplinary action.

(5) Proof of completion of a written jurisprudence exam.

(6) Authorization for background inquiries to other sources. These may be conducted as determined by the commission including, but not limited to, the national practitioner data bank and drug enforcement agency.

(7) Any fees incurred in obtaining verification of requirements.

(8) Any other information for each license type as determined by the secretary.

(9) Fees as required in WAC 246-819-990.