N.H. Admin. Code § Pari 806.05

Current through Register No. 50, December 12, 2024

Section Pari 806.05 - Application Form for Occupational Licensees for Positions Other Than Judge

On a form provided by the commission, an applicant for an occupational license other than that of judge under Pari 806.01(8) shall supply the following information:

(a) The type of license for which the applicant is applying;

(b) The year for which the applicant is applying for a license;

(c) The applicant's full name;

(d) The applicant's date of birth;

(e) The applicant's place of birth;

(f) The applicant's social security number or, if the applicant is not an individual, the applicant's federal tax identification number;

(g) The street address of the applicant's residence;

(h) The applicant's residential mailing address, if different from the street address;

(i) The telephone number of the applicant's residence;

(j) The applicant's personal e-mail address;

(k) A description of the applicant, including the applicant's:

(1) Age;

(2) Gender;

(3) Height;

(4) Weight;

(5) Hair color; and

(6) Eye color;

(l) Whether the applicant is married or single;

(m) Whether or not the applicant is a citizen of the United States;

(n) If the applicant is not a citizen of the United States, the name of the nation in which the individual holds citizenship and a description of the documentation possessed by the applicant relative to his or her presence in the United States, together with any identifying numbers assigned to that documentation;

(o) The trade name, if any, under which the applicant proposes to conduct business;

(p) The name, address and telephone number of the applicant's present employer, if any;

(q) The title of the applicant's current job;

(r) If the applicant is a corporation, partnership or other association, the name, title within the association, address and telephone number of each of the applicant's officers, directors, trustees and owners;

(s) The street address of the applicant's principal place of business;

(t) The mailing address of the applicant's principal place of business, if different from the street address;

(u) The applicant's business e-mail address;

(v) The name, address, telephone number and relationship of the applicant's nearest living relative;

(w) Whether or not the applicant is able to perform those duties of the position for which he or she is applying for occupational licensure as set forth in the rules of the commission;

(x) Whether or not, within the past 10 years, the applicant, and any of the applicant's officers, directors, owners or trustees, if any, has or have been convicted of or pleaded guilty to any felony as an adult, in any jurisdiction, that has not been annulled;

(y) If the answer to question (x) is yes:

(1) The name of each person or association convicted or which pleaded guilty;

(2) A description of each felony;

(3) The date of each conviction or guilty plea;

(4) The name and location of the court where the applicant, officer, director, owner or trustee was convicted or pleaded guilty; and

(5) A description of each sentence imposed;

(z) Whether or not, within the past 10 years, the applicant , and any of the applicant's officers, directors, owners or trustees, if any, has or have been convicted of or pleaded guilty to violation of any law relative to gaming or gambling or law relating to cruelty to animals, which has not been annulled;

(aa) If the answer to (z) above is yes,

(1) The name of each person or association convicted or which pleaded guilty;

(2) A description of each offense;

(3) The date of each conviction or guilty plea;

(4) The name and location of the court where the applicant, officer, director, owner or trustee was convicted or pleaded guilty; and

(5) A description of each sentence imposed;

(ab) Whether or not, within the past 2 years, the applicant, and any of the applicant's officers, directors, owners or trustees, if any, has or have been convicted of or pleaded guilty to any misdemeanor as an adult, in any jurisdiction, that has not been annulled which involves a controlled substance;

(ac) If the answer to question (ab) is yes:

(1) The name of each person or association convicted or which pleaded guilty;

(2) A description of each misdemeanor;

(3) The date of each conviction or guilty plea;

(4) The name and location of each court where the applicant, officer, director, owner or trustee was convicted or pleaded guilty; and

(5) A description of each sentence imposed;

(ad) Whether or not the applicant, and any of the applicant's officers, directors, owners or trustees, if any, is or are currently subject to the revocation or suspension of a license or occupational license relating to pari-mutuel wagering, dog racing or horse racing in this or any other jurisdiction;

(ae) If the answer to question (ad) is yes:

(1) The name of each person or association so subject;

(2) The jurisdiction in which each suspension or revocation occurred;

(3) The date of each revocation or suspension; and

(4) A description of the terms of each revocation or suspension;

(af) Whether or not the applicant, and any of the applicant's officers, directors, owners or trustees, if any, is or are currently not the holder of a license or occupational license relating to pari-mutuel wagering, dog racing or horse racing license issued in this or any other jurisdiction because such a license or occupational license was voluntarily surrendered while a proceeding was pending against the applicant for alleged misconduct;

(ag) If the answer to question (af) is yes:

(1) The name of each person or association making such a surrender;

(2) The jurisdiction in which the surrender was made;

(3) The date of the surrender; and

(4) A description of the alleged misconduct;

(ah) Whether or not the applicant, and any of the applicant's officers, directors, owners or trustees, if any, is or are currently subject to exclusion from any premises at which the racing of horses or dogs or pari-mutuel wagering is held;

(ai) If the answer to (ah) above is yes:

(1) The name of the person or association so subject;

(2) The jurisdiction imposing the exclusion;

(3) The date and terms of the exclusion; and

(4) The reason for such exclusion;

(aj) Whether or not the applicant, and any of the applicant's officers, directors, owners or trustees, if any, is or are currently subject to a determination that he or she is ineligible to engage in the racing or training of any horse or dog, or to engage in pari-mutuel wagering, as the result of misconduct in this or any other jurisdiction;

(ak) If the answer to (aj) above is yes:

(1) The name of the person or association subject to the determination;

(2) The jurisdiction making the determination;

(3) The date of the determination; and

(4) The reason for the determination;

(al) Whether or not the applicant, and any of the applicant's officers, directors, owners or trustees, if any, has or have ever owned, operated or been associated in any way with any illegal gambling enterprise;

(am) Whether or not the applicant, and any of the applicant's officers, directors, owners or trustees, if any, has or have previously been licensed by commission and, if so:

(1) The name of each person or association holding a license;

(2) The type of license held; and

(3) The year or years of such licensure;

(an) Whether or not the applicant, and any of the applicant's officers, directors, owners or trustees, if any, has or have previously been licensed by an agency, commission or other authority in another state or nation that is responsible for issuing licenses relative to pari-mutuel wagering, greyhound racing or horse racing and, if so:

(1) The name of each person or association so licensed;

(2) The name of each jurisdiction in which a license was held;

(3) Each type of license held; and

(4) The year or years of such license or licenses.

(ao) The applicant's signature, or, if the applicant is a corporation or other form of association, the signature of the applicant's duly authorized representative, on a statement preprinted on the form stating that:

(1) The applicant agrees to abide by the rules of the New Hampshire racing and charitable gamingcommission and the laws of the State of New Hampshire relative to dog racing, horse racing and pari-mutuel wagering;

(2) The information provided on the application form is true, accurate and complete; and

(3) The applicant acknowledges that, pursuant to RSA 641:3, making a false statement on this application form is punishable as a crime; and

(ap) The date of the signature described in (ao) above.

N.H. Admin. Code § Pari 806.05

#8049, eff 2-25-04; ss by #9248, 8-29-08