N.H. Admin. Code § Saf-C 4904.02

Current through Register No. 45, November 7, 2024

Section Saf-C 4904.02 - Form DSFM 87

(a) An applicant shall supply the following on form DSFM 87:

(1) The applicant's:

a. Name;

b. Address;

c. Telephone number;

d. E-mail address, if available; and

e. Date of birth;

(2) The employer's:

a. Name;

b. Address;

c. Telephone number; and

d. E-mail address, if available; and

(3) An indication as to whether the application is an original or renewal.

(b) The applicant shall sign and date the application under the penalty of unsworn falsification, pursuant to RSA 641:3.

N.H. Admin. Code § Saf-C 4904.02

#8650, eff 6-2-06; ss by #9766-B, eff 8-3-10