N.H. Admin. Code § Inst 301.04

Current through Register No. 50, December 12, 2024

Section Inst 301.04 - Application Form, Inst 3

(a) Applicants for licensure shall provide the following on Inst 3:

(1) Applicant's name and any names previously used;

(2) Applicant's:

a.Home address;

b.Business address;

c.Home and business telephone number;

d.Home and business e-mail address; and

e.Business facsimile number;

(3) Applicant's date and place of birth;

(4) Applicant's educational history, including the names and dates attended at each educational institution;

(5) Applicant's employment history, including:

a.Employer's name and address;

b.Dates of employment; and

c.Nature of employer's business;

(6) Names and addresses of 3 references of persons unrelated to the applicant who:

a.Have personal knowledge of the applicant's professional character or reputation;

b.May attest to the reputation, character, honesty, ethics or technical competence of the applicant; and

c.Are related to the manufactured housing, building construction, banking or other relevant field;

(7) If the applicant is a non-New Hampshire resident, the name of the resident agent in state;

(8) Indication as to whether the applicant is licensed as an installer in other states, and if so, the names of the other states;

(9) Indication as to whether the applicant was ever refused an installer's license in any other state;

(10) Indication as to whether the applicant has been the subject to disciplinary action in any other state, and if so a description of the incident;

(11) Disclosure of whether the applicant has:

a.In the last 3 years been convicted of mishandling funds or other property entrusted to the applicant by another party, and if so, the court of conviction and disposition;

b.Filed bankruptcy, and if so, the dates of prior filings;

c.Been convicted of a misdemeanor or felony or a crime other than a minor traffic offense, that has not been annulled;

d.Been sued civilly, and if so an explanation; and

e.Been convicted of any crime, and if so, the date and the name of the court; and

(12) Indication as to whether the applicant will pick-up the license when ready.

(b) An applicant shall submit the following along with Inst 3:

(1) For the purposes of (a)(4) above:

a.Any proof of formal education beyond high school in the form of a copy of transcripts or proof of graduation; and

b.Any proof of special training classes attended in the form of a certificate.

(2) Proof of 2 years of actual installation of manufactured homes, under the direction of a licensed manufactured housing installer, or equivalent experience;

(3) Proof of financial responsibility, pursuant to Inst 302;

(4) Proof of successful completion of an initial 6 hour board approved training program, pursuant to RSA 205-D:8, III,completed within 3 years of the date of the application;

(5) A recent 2 inch by 2 inch current passport photograph of the applicant; and

(6) Applicable application fee.

(c) An application shall be signed and dated by the applicant and sworn to before a notary or justice of the peace. Any false statements made on the application shall be subject to the penalty provided under RSA 641:2.

N.H. Admin. Code § Inst 301.04

#8494, eff 12-24-05; ss by #10115, eff 4-14-12