New Hampshire Code of Administrative Rules
Mtec - Board of Registration of Medical Technicians
Chapter Mtec 400 - CONTINUED STATUS
Part Mtec 401 - RENEWAL OF REGISTRATION; REINSTATEMENT
Section Mtec 401.04 - Reinstatement of Registration
Universal Citation: NH Admin Rules Mtec 401.04
Current through Register No. 12, March 21, 2024
(a) A registrant whose registration has expired may apply for reinstatement of the registration on the "Application for Reinstatement of Registration" form supplied by the board, and provide the following information:
(1) Legal name, as it should appear on the
registration;
(2) Any other name
used, including a maiden name, if different from (1) above;
(3) Former registration number, if
any;
(4) Home street and mailing
address;
(5) Telephone number and
e-mail address;
(6) The applicant's
intended or current occupation, profession or job;
(7) A list of all places where the applicant
has been employed at any time since registration lapsed and ending upon the
date of the application, together with:
a. The
name and address of the employer;
b. Dates that the employment began and ended;
and
c. The reason for leaving the
employment;
(8) A "Yes"
or "no" answer to the following questions relating to circumstances occurring
since the registration has lapsed or which have not previously been disclosed
to the Board:
a. "Have you ever received
disciplinary action against any license, certification or registration in any
state or jurisdiction, including a reprimand, probation, suspension,
revocation, education or practice stipulations, fines or voluntary
surrender?"
b. "Are you currently,
or have you previously been impaired by or diverted any chemical substances
that impaired your ability to practice?"
c. "Have you ever been convicted of a felony
under the laws of the United States or any state or any offense involving moral
turpitude?"
(9) The
applicant's signature on a statement, which shall be signed, dated and
acknowledged before a notary public or justice of the peace that:
a. The information and documentation provided
on all parts of the application form and submitted to support the application
is complete and accurate to the best of the applicant's information and
belief;
b. Knowingly making a false
statement in the application is a misdemeanor under
RSA 641:2,
I; and
c. The applicant has read RSA 328-I and the
rules of the board, and promises that if registered, will abide by
them.
(b) The request for reinstatement shall be accompanied by the following:
(1) The fee established by the board pursuant
to Mtec 305.01; and
(2) A letter of
explanation for any "yes" answer provided in response to the questions
described in (a)(8) above.
Disclaimer: These regulations may not be the most recent version. New Hampshire may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.