Section Plc 305.04 - Information and Verification Required for a Temporary License An applicant for a temporary license shall identify the profession for which the application is being filed and the date the application for initial licensure was filed or is expected to be filed, and then provide the following information and verification:
(a) The applicant's full legal name including any suffix such as "Jr." or "III", and any other name(s) in which the applicant holds or has held a license;(b) The applicant's date of birth by month, day, and year;(c) The applicant's social security number, as required by RSA 161-B:11, VI-a and 42 U.S.C. 666(a)(13);(d) The applicant's home physical address by street name and number, apartment number if any, municipality, county, state, zip code, and country if not the U.S., and home mailing address if different;(e) The applicant's home or other personal telephone number;(f) The applicant's designated email address;(g) Whether the applicant is on active military duty or the spouse of an individual on active military duty;(h) Identification of each U.S. jurisdiction where the applicant holds an active license and for each, the license number, date of most recent licensure, and whether the license is in good standing;(i) An answer to the question "Have you committed any acts or omissions that are grounds for disciplinary action in another jurisdiction?"(j) If the answer to the question in (i), above, is in the affirmative, a detailed letter of explanation explaining the circumstances and any disciplinary or non-disciplinary action taken;(k) Whether the applicant consents to the disclosure to third parties of any or all of the applicant's contact information; and(l) Verification of licensure from a jurisdiction listed pursuant to (h), above, that has licensure requirements in the applicable profession that are substantially equivalent to or more stringent than those of New Hampshire, in the form of an official verification or a printout from an on-line license verification system.N.H. Admin. Code § Plc 305.04
Derived From Volume XXXVIII Number 41, Filed October 11, 2018, Proposed by #12621, Effective 9/21/2018, Expires 9/21/2028.Amended by Number 15, Filed April 13, 2023, Proposed by #13606, Effective 5/1/2023, Expires 5/1/2033.