Section Plc 1104.01 - Initial License Application Submission(a) Any individual who is 18 years or older on the date of application, as required by RSA 328-H:8, I(a), who wishes to engage in the practice of reflexology, structural integration, or Asian bodywork therapy who is not already licensed in New Hampshire shall file an application for an initial practitioner license in accordance with this section.(b) Each applicant for initial licensure shall submit an "Application for State of New Hampshire License to Practice Reflexology, Structural Integration, or Asian Bodywork Therapy" form, revised April 2022, that contains the following: (1) Whether the applicant is applying for a license to practice reflexology, structural integration, or Asian bodywork therapy;(2) The applicant's first name, middle name, and last name;(3) The applicant's date of birth, including the month, day, and year;(4) The applicant's social security number as required by RSA 161-B:11, VI-a and 42 U.S.C. 666(a)(13);(5) The applicant's home mailing address; (6) The applicant's daytime telephone number including area code;(7) The applicant's personal email address;(8) The name of each jurisdiction where the applicant holds or held any professional license or certificate, whether to practice reflexology, structural integration, or Asian bodywork therapy or any other related or unrelated profession, and for each, the following:a. The profession in which the applicant is or was licensed;b. The number of years the applicant was licensed; andc. The status of the license or certificate, including whether a license or certificate was denied or is active, suspended, or revoked;(9) The name, location, telephone number including area code, website URL if any, and email address if any of the business at which the applicant works or intends to work, if known;(10) A yes or no answer to whether the applicant has been convicted of any crime involving violence inflicted on a person or threatened against a person, or any sexually-related crime, in accordance with RSA 328-H:8, I(d); and(11) The applicant's dated signature under the following pre-printed statement, provided that when the application becomes available on-line, the act of submitting the application shall constitute the applicant's signature and the date of submission shall be the date: "By my signature I attest full compliance with RSA 328-H and all corresponding New Hampshire rules and that the information and documentation provided are true, complete, and not misleading to the best of my knowledge and belief. I understand that knowingly providing false or misleading information may be grounds for denial, suspension, or revocation of a license."
(c) Each applicant for initial licensure shall provide the following additional documents and payments with his or her application:(1) Documentation of current certification by the applicant's respective certifying organization, as listed in Plc 1107.02;(2) If the applicant has been denied any professional license or if the applicant holds or held a professional license that was suspended or revoked, or for which any disciplinary action was taken by the applicable regulatory authority, a written explanation detailing the circumstances surrounding each such action that includes the profession, date of action, reason(s) for action, and any other information the applicant believes is relevant;(3) If the applicant answers "yes" to the question regarding specified criminal convictions, a written explanation detailing the circumstances surrounding each such conviction that includes the date and jurisdiction of the conviction and any other information the applicant believes is relevant; and(4) The application processing fee required by Plc 1002.(d) The application, together with the additional documents and payment required by (c), above, shall be submitted to the executive director.(e) If the application is denied in accordance with Plc 1104.02(e), the application processing fee shall not be refunded to the applicant.N.H. Admin. Code § Plc 1104.01
Derived from Volume XLII Number 28, Filed July 14, 2022, Proposed by #13391, Effective 5/27/2022, Expires 5/27/2032 (See Revision Note at chapter heading for Plc 1100).