New Hampshire Code of Administrative Rules
Saf - Department of Safety
Subtitle Saf-C - Commissioner, Department of Safety
Chapter Saf-C 5900 - EMERGENCY MEDICAL SERVICES RULES
Part Saf-C 5904 - PROVIDER LICENSING STANDARDS
Section Saf-C 5904.03 - Provider License Application Statement of Certification

(a) The information provided in the application is complete, truthful, and correct under penalties of unsworn falsification pursuant to RSA 641:3;

(b) He or she has not been convicted or found guilty of an offense pursuant to RSA 153-A:13, I;

(c) He or she complies with RSA 153-A and these rules;

(d) He or she understands any material falsification of information shall result in license denial, suspension, or revocation, in accordance with Saf-C 5922.03 or Saf-C 5922.05 and may be grounds for a misdemeanor conviction pursuant to RSA 641:3;

(e) He or she has not been subject to limitation, suspension from, or under revocation or probation of the ability to practice in a health care occupation or voluntarily surrendered a health care license in any state or to any agency authorizing the right to work; and

(f) If the applicant is unable to certify compliance with Saf-C 5904.03(b) to 5904.03(e) the applicant shall provide official documentation that fully describes the offense, current status, and disposition of the case.