Section Lan 301.02 - Application for Licensure(a) Each applicant for licensure shall provide, or cause to be provided, the following on or with an application for licensure form:(1) The applicant's name, including any names previously used;(2) The applicant's residence and business name and title, addresses, telephone numbers and e-mail address;(3) The applicant's date and place of birth;(4) The applicant's positions, dates of employment, type of services provided, title, and present address of all employers/clients referenced;(5) Position title and description of duties for each position including location and character of each position and degree of responsibility;(6) Name and present address of someone familiar with each position listed in (5) above;(7) The applicant's educational history including:a. The names of all high school and post-secondary institutions attended;b. The dates of attendance and degrees awarded; andc. Certified copies of transcripts from all post-secondary institutions attended;(8) If applicable, the state in which the applicant was first registered or licensed as a land surveyor, date of licensure, and license number;(9) Whether the applicant has ever applied for land surveying licensure in New Hampshire and the status;(10) A listing of every state in which the applicant holds or has ever held registration/licensure as a land surveyor including license number, year, state, number of hours of written examination, whether the license was reciprocity or grandfather and whether the license is active or lapsed;(11) Whether the applicant still holds theregistrations/licenses listed in (8) above and if not, the reasons why, using additional pages as necessary;(12) Whether the applicant has ever lost or been denied registration/licensure as a land surveyor or disciplined by another licensing board in any other state and if so, an explanation of the circumstances;(13) Whether the applicant has ever taken the NCEES Fundamentals of Surveying examination, and if so, the state, date, total number of hours of written exam, the certificate number, and grade awarded;(14) Whether the registrations/licenses listed in (10) above as a land surveyor were issued by NCEES examination, if not how and if so, the locations, dates and grades awarded;(15) Whether the applicant has ever been convicted of any felony or any misdemeanor, or a violation involving land surveying or the practice of land surveying and if so, the name of the court, the details of the offense and the date of conviction and the sentence imposed;(16) The names, complete addresses, occupation, and business relationship with the applicant of 5 references as specified in Lan 301.03, provided that current board members shall not be accepted as references;(17) A list of current memberships in professional or scientific societies, which shall include name of organization, location, grades, dates of memberships and any additional experience information the applicant wishes to provide;(18) Whether the applicant is applying for facilitated licensure as a military spouse;(19) The applicant's social security number required pursuant to RSA 161-B:11, VI-a;(20) An affidavit acknowledging that the applicant has provided correct and true information;(21) The survey reports as specified in Lan 302.04(b); and(22) The applicant's signature and date.(b) Applicants shall pay the application fee specified in Lan 304.01.(c) Verification of licensure and examination shall be obtained by the candidate for licensure and submitted to the board directly from the verifying state for approval, by using the form described in Lan 301.06.N.H. Admin. Code § Lan 301.02
#5934, eff 12-9-94, EXPIRED: 12-9-00
New. #7425, INTERIM, eff 1-13-01, EXPIRED: 7-12-01
New. #7549, eff 8-25-01; ss by#9340, eff 1-1-09
Amended by Volume XXXVI Number 45, Filed November 10, 2016, Proposed by #12031, Effective 11/1/2016, Expires 11/1/2026.