Section Agr 1404.06 - Application Form for Initial Certificate of Registration as a Service Technician(a) Any person who wishes to receive an initial certificate of registration as a service technician shall complete and submit to the commissioner the application form entitled "Application Form for Initial Certificate of Registration". (b) The applicant shall supply the following: (2) The applicant's name, including last, first and middle;(3) The applicant's residence address, including street, city, state and 9-digit zip code;(4) The applicant's mailing address, if different from the address in (3) above;(5) The applicant's residential telephone number;(6) The applicant's date of birth;(7) The applicant's driver's license number and state and county of issuance;(8) The applicant's e-mail address;(9) If the applicant has held a service technician registration under another name, that other name;(10) If the applicant has lived fewer than 5 years at the current address, the applicant's residential addresses for the past 5 years, including street, city, state and 9-digit zip code;(11) For the applicant's present employer: d. The toll-free telephone number;f. The name of the business;g. The business's address, including street number, city, state, 9-digit zip code; andh. The business's mailing address if different from the address for g. above;(12) For the applicant's most recent previous employer for which the applicant held a certificate of service technician registration:a. The name of the business; andb. The business's address, including street number, city, state and 9-digit zip code;(13) The particular device categories selected from the list in Agr 1404.03(c) for which the applicant wishes to be registered;(14) A list of test weights to be used by the applicant after registration;(15) A list of test measures to be used by the applicant after registration;(16) A list of any other types of test equipment to be used by the applicant after registration;(17) If the test equipment has already been certified, the date it was certified; and(18) If the test equipment has already been certified, the laboratory where it was certified.(d) On a separate page the applicant shall supply his or her social security number on the space provided beneath the following preprinted notice: "The Commissioner of the Department of Agriculture, Markets and Food will deny registration if you refuse to submit your social security number (SSN). Your certificate of registration will not display your SSN. Your SSN will not be made available to the public.
The Commissioner is required to obtain your social security number for the purpose of child support enforcement in compliance with 42 USC 666(a)(13) and RSA 161-B:11. This collection of your social security number is mandatory."
(e) An applicant for a certificate of registration shall read, sign and date "Application Form for Initial Certificate of Registration" which states: "I understand that the only standards to be used shall be those certified by an accredited laboratory. If the standards are certified by an accredited laboratory other than the division's, I shall be required to submit a certificate from the other accredited laboratory before a registration certificate can be issued to me. I certify that I possess or have available the necessary standards and testing equipment to service those device categories for which I am requesting a certificate of registration."
(f) An applicant for a certification shall read, sign, and date "Application Form for Initial Certificate of Registration" below the following preprinted statement: "I certify that I have a current edition of NIST Handbook 44 and of NIST Handbook 112. I certify that I have a current copy of Agr 1400, the administrative rules pertaining to weights and measures. I promise that I shall operate in accordance with those rules. I certify that there are no willful misrepresentations, falsifications or material omissions in the information provided on this application. I understand that, if an investigation discloses any willful misrepresentations, falsifications or material omissions, my application will be rejected. I understand that, if after issuance of a certificate of registration to me, an investigation should disclose any willful misrepresentations, falsifications or material omissions, the certificate of registration will be invalid and I will be subject to an administrative fine under RSA 438:40, IV and possible prosecution under RSA 641:2."
(g) The meaning of the signature required by (e) above shall be the signer's: (1) Statement of understanding that the only standards to be used shall be those certified by the division of weights and measures laboratory or another accredited laboratory;(2) Statement of understanding that, if the standards are certified by another accredited laboratory, the applicant shall be required to submit a certificate from the other accredited laboratory before a registration certificate can be issued; and(3) Certification that the applicant possesses or has available the necessary standards and testing equipment to service those device categories for which the applicant is requesting a certificate of registration.(h) The meaning of the signature required by (f) above shall be the signer's:(1) Certification that he or she possesses current editions of NIST Handbook 44 and NIST Handbook 112;(2) Certification that he or she has a current copy of Agr 1400 and promise to operate in accordance with Agr 1400;(3) Certification that there are no willful misrepresentations, falsifications or material omissions in the information provided on the application form;(4) Statement of understanding that if an investigation discloses any willful misrepresentations, falsifications or material omissions, his or her application will be rejected; and(5) Statement of understanding that, if an investigation after issuance of a registration certificate to the applicant should disclose any willful misrepresentations, falsifications or material omissions, the certificate of registration will be invalid and the applicant will be subject to an administrative fine under RSA 438:40, IV and possible prosecution under RSA 641:2.N.H. Admin. Code § Agr 1404.06
(See Revision Note at chapter heading for Agr 1400) #7462, eff 3-21-01; ss by #9416, INTERIM, eff 3-13-09, EXPIRED: 9-9-09
New. #9639, eff 1-20-10
Amended by Volume XXXVII Number 50, Filed December 14, 2017, Proposed by #12424, Effective 12/1/2017, Expires 12/1/2027.