Section Pari 605.10 - Supplemental Application Form for Veterinarian or Veterinarian AssistantOn a form provided by the commission, an applicant for an occupational license as a veterinarian or veterinarian assistant shall, in addition to the application form specified in Pari 605.05, supply the following:
(a) The name of the applicant as it appears on the form specified in Pari 605.05;(b) Whether or not the applicant currently possesses a license to practice veterinary medicine in the state of New Hampshire;(c) The names of all jurisdictions in which the applicant has been admitted to the practice of veterinary medicine and the year of admission to practice;(d) Whether or not the applicant's license to practice veterinary medicine in this or any other jurisdiction is subject to suspension or revocation;(e) The name, address and telephone number of the person, corporation or association licensed under RSA 284:15 recommending the applicant for occupational licensure;(f) In the case of a veterinarian assistant, the name, address and telephone number of an occupationally licensed veterinarian who has agreed to supervise the applicant;(g) The applicant's signature on the statement set forth in Pari 605.28; and(h) The date of the signature described in (g) above.N.H. Admin. Code § Pari 605.10