(1) “License” shall include any license, permit, or other comparable authority issued by the Board or an original licensing jurisdiction to practice dentistry, practice under an affiliated permit, or provide dental supportive procedures as a dental auxiliary.

(2) “Disciplined” means that the applicant's license has been placed on probation, revoked, suspended, reproved, censured, reprimanded, restricted, limited, or conditioned.

(3) “Jurisdiction” shall mean a state, district, or territory of the United States, or another country.

(4) “Disciplinary proceeding” shall mean any proceeding or investigation under the authority of the licensing jurisdiction pursuant to which licensee discipline may be imposed on the applicant.

(5) “Provide dental supportive procedures as a dental auxiliary” shall mean providing the services within the scope of practice of a registered dental assistant, registered dental assistant in extended functions, orthodontic assistant, or dental sedation assistant as defined in Sections 1750.3, 1750.5, 1752.4, 1753.5, 1753.55, 1753.6, and of the Code, as applicable, and sections 1086 and 1087 of this Division, as applicable.

(6) “Good standing” shall mean that the applicant has not been disciplined, is not the subject of an unresolved complaint or review procedure, and is not the subject of any unresolved disciplinary proceeding.

(7) “Original licensing jurisdiction” shall mean the jurisdiction agency or board that issued a license to the applicant authorizing the applicant to practice within the same scope of practice for which the applicant seeks a temporary license from the Board.

(8) “Affiliated permit” shall mean any permit or endorsement associated with either a dentist license or physician and surgeon license, as applicable, and issued by the Board to practice as an elective facial cosmetic surgeon, oral and maxillofacial surgeon, or to administer general anesthesia or moderate sedation to an adult and/or pediatric patient, oral conscious sedation for adult patients, or pediatric minimal sedation as specified in Sections 1638, 1638.1, 1646, 1646.1, 1646.2, 1646.9, 1647.1, 1647.2, 1647.3, 1647.18, 1647.19, 1647.30 and 1647.31 of the Code.

(9) “Successfully complete” shall mean that an applicant has achieved a criterion-referenced passing score as defined in Section 1031.

(1) The applicant's application type and contact information, including:

(2) The applicant shall disclose whether the applicant is married to, or in a domestic partnership or other legal union with, an active duty member of the Armed Forces of the United States who is assigned to a duty station in California under official active duty military orders. If the applicant answers in the affirmative, the applicant shall provide the following documentation with the application:

(3) The applicant shall disclose whether the applicant holds a current, active and unrestricted license to practice dentistry, practice within the scope of practice of an affiliated permit or provide dental supportive procedures as a dental auxiliary in another state, district, or territory of the United States, and whether such license is the same type of license that the applicant is applying for with the Board. If the applicant answers in the affirmative, the applicant shall provide written verification from the applicant's original licensing jurisdiction that the applicant's license is in good standing in that jurisdiction.

The verification shall include all of the following:

(4) The applicant shall disclose whether the applicant holds or has ever held any other license to practice dentistry or provide dental supportive procedures as a dental auxiliary in another state, district, or territory of the United States. If the applicant answers in the affirmative, the applicant shall provide written verification from each of the applicant's original licensing jurisdiction(s) that the applicant's license is in good standing in that jurisdiction. The verification shall include all of the following:

(5) The applicant shall furnish fingerprints to the Board in compliance with subsection (d) to permit the Board to conduct a criminal history record check through the California Department of Justice.

(6) For applicants seeking a temporary license to practice as a dentist, the applicant shall furnish proof of successful completion of the California law and ethics examination specified in subsection (c). “Proof of successful completion” shall mean a copy of the applicant's report or notice issued by the examination administrator PSI Services LLC (PSI) that lists the applicant's name and indicates that the applicant passed the examination.

(7) The following statement and notice, signed and dated by the applicant:

I hereby attest that I meet all of the requirements for temporary licensure as set forth in Business and Professions Code Section 115.6(c)(1) through (5), including that I have not committed an act in any jurisdiction that would have constituted grounds for denial, suspension, or revocation of the license under the Business and Professions Code at the time the act was committed and I am aware that a violation of this paragraph may be grounds for the denial or revocation of a temporary license issued by the Board. I also attest to the fact that I have not been disciplined by a licensing entity in another jurisdiction and am not the subject of an unresolved complaint, review procedure, or disciplinary proceeding conducted by a licensing entity in another jurisdiction. I also understand that I will be required to furnish a full set of fingerprints for purposes of conducting a criminal background check. I further attest that the information submitted in this application is accurate, to the best of my knowledge.

Notice: Falsification or misrepresentation of any item or response on this application or any attachment hereto is grounds for denying the application. In addition, any temporary license issued after the application is processed will be immediately terminated upon a finding that the license holder provided substantively inaccurate information that would affect the person's eligibility for temporary licensure (Bus. & Prof. Code, § 115.6).

(1) To take the examination, each applicant shall submit a completed application for approval to test to the Board that contains all of the following:

(2) After receipt of a completed application for approval to test, and upon the Board's determination that the applicant has met the requirements of paragraphs (1) and (2) of subdivision (c) of Section 115.6 of the Code, the Board shall mail a written and dated notice of approval to test to the applicant and PSI. The notice shall also contain the web site address, email address, telephone number and mailing address for the applicant to contact PSI to schedule the examination.

(3) Upon receipt of written notice of approval to test from the Board, an applicant is responsible for contacting PSI to schedule a test date and examination site location, and paying PSI's nonrefundable fees to take the examination.

(1) Subject to paragraph (3), all applicants must submit fingerprints through the California Department of Justice's electronic fingerprint submission Live Scan Service (“Live Scan”) by completing the California Department of Justice Form “Request for Live Scan Service,” and submitting fingerprinting, through Live Scan as described in this subsection.

(2) Each applicant shall take the completed “Request for Live Scan Service” form to a Live Scan location to have their fingerprints taken by the operator. The applicant will be required to pay all fingerprint processing fees payable to the Live Scan operator, including the Live Scan operator's “rolling fee,” if any, and fees charged by the California Department of Justice and the Federal Bureau of Investigation. For current information about fingerprint background checks, and Live Scan locations, please visit the Attorney General's website at: https://oag.ca.gov/fingerprints.

(3) Applicants residing outside of California who cannot be fingerprinted electronically through Live Scan in California must have their fingerprints taken at a law enforcement agency in their state of residence, using fingerprint cards. Applicants shall complete and mail two fingerprint cards, together with the California Department of Justice and the Federal Bureau of Investigation fingerprinting fees (either personal check drawn on a U.S. bank, money order or certified check), payable to the “Dental Board of California,” to:

(1) Prior to or at the same time as the applicant submits an application for the temporary license to practice under an affiliated permit, apply for a temporary dentist license using the application specified in subsection (b) for permits issued pursuant to Sections 1638.1, 1646.1, 1647.2, 1647.19, or 1647.31 of the Code; or

(2) Have a current, active, and unrestricted license as a physician and surgeon from the Medical Board of California for permits issued pursuant to Sections 1638 and 1646.9 of the Code.