The purpose of this paragraph is to define disciplinary actions that the Board may impose on licensees.
Petition for Order of Compliance
Board of Electrolysis Examiners
Petitioner's Name: ________________________
Petitioner's Mailing Address: ________________________
________________________
________________________
Petitioner's E-Mail Address: ________________________
Telephone Number: ________________________
Attorney for Petitioner: ________________________
Attorney's Mailing Address: ________________________
________________________
________________________
Attorney's E-Mail Address: ________________________
Telephone Number: ________________________
The petitioner respectfully represents, as substantiated by the attached documentation, that all provisions of the attached disciplinary order have been complied with and I am respectfully requesting: (circle one)
Note - You must enclose all documents necessary to prove your request including a copy of the original order. If any of the proof you are relying upon to show compliance is the testimony of any individual, including yourself, you must enclose signed statements from every individual you intend to rely upon attesting, under oath, to the compliance. The Board's consultant and administrative staff, in their discretion, may require such signed statements to be notarized. No documentation or testimony other than that submitted will be considered in making an initial determination on, or a final order in response to, this petition.
Respectfully submitted this the____day of_________________, 20___.
__________________________
Petitioner's Signature
Petition for Order Modification
Board of Electrolysis Examiners
Petitioner's Name: _______________________
Petitioner's Mailing Address: _______________________
_______________________
_______________________
Petitioner's E-Mail Address: _______________________
Telephone Number: _______________________
Attorney for Petitioner: _______________________
Attorney's Mailing Address: _______________________
_______________________
_______________________
Attorney's E-Mail Address: _______________________
Telephone Number: _______________________
The petitioner respectfully represents that for the following reasons, as substantiated by the attached documentation, the identified provisions of the attached disciplinary order are impossible for me to comply with:
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
Note - You must enclose all documents necessary to prove your request including a copy of the original order. If any of the proof you are relying upon to show impossibility is the testimony of any individual, including yourself, you must enclose signed and notarized statements from every individual you intend to rely upon attesting, under oath, to the reasons why compliance is impossible. No documentation or testimony other than that submitted will be considered in making an initial determination on, or a final order in response to, this petition.
Respectfully submitted this the____day of_________, 20____.
___________________________
Petitioner's Signature
Tenn. Comp. R. & Regs. 0540-01-.15
Authority: T.C.A. §§ 4-5-101, 4-5-202, 4-5-204, 4-5-217, 4-5-223, 63-1-122, 63-1-134, 63-26-108, 63-26121, and 63-26-123.