N.H. Admin. Code § Alc 316.05

Current through Register No. 2, January 9, 2025

Section Alc 316.05 - Report Form Documenting Hours of Experience as an Alcohol and Drug Counselor

The report form documenting hours of experience as a licensed alcohol and drug counselor or master licensed alcohol and drug counselor shall require:

(a) The applicant's full name;

(b) The date the form was completed;

(c) The information detailed in (d) below to be reported separately for each site of the applicant's paid work experience for the previous 10 years, listed in sequential order;

(d) The provision of the following information:

(1) The applicant's job title;

(2) The dates of employment;

(3) The duties performed by the applicant;

(4) The percentage of the applicant's time spent in alcohol or drug abuse counseling;

(5) Whether the job was full time, part time or, if neither, an explanation of the structure of employment;

(6) The hours worked per week;

(7) The employer's name;

(8) The employer's address;

(9) The employer's telephone;

(10) The applicant's supervisor's name; and

(11) The total number of hours of experience earned at this job site.

N.H. Admin. Code § Alc 316.05

Derived From Volume XXXVI Number 45, Filed November 10, 2016, Proposed by #12001, Effective 10/13/2016, Expires 10/13/2026.