1. (a) Every applicant for an initial employee leasing company license shall complete, sign, have the signature acknowledged by a notary public, and file with the commissioner “Employee Leasing Application” form WC-EMPLSNG Rev. 08/2022, together with a non-refundable application fee of $100. This application fee shall be in addition to the annual license fee set by Lab 1504.

2. (b) The applicant for an employee leasing company license shall supply the following on or attached to form “Employee Leasing Application”:

   1. (1) A department of safety, division of state police, notarized “Criminal Record Release Authorization”, pursuant to rule Saf-C 5703, along with any required fee, with the commissioner identified as the recipient of the record or records, authorizing a criminal background check for each principal, officer, manager, or individual who owns 10 percent or more or exercises the power to control day to day operation or direction of the applicant;
   2. (2) Proof of the applicant's workers’ compensation coverage as described by RSA 281-A:5 for all leased employees of the applicant;
   3. (3) If applicable, certification that the health insurance policy provided complies with the requirements of RSA 277-B:11;
   4. (4) Certification pursuant to RSA 277-B:5,VI that the applicant does not conduct a temporary help service through the same entity as the applicant's employee leasing company;
   5. (5) The applicant’s audited financial statement prepared by an independent certified public accountant in accordance with generally accepted accounting principles within 13 months prior to the date of application which shows a minimum working capital of $100,000, pursuant to RSA 277-B:6, I;
   6. (6) A copy of the manual provided to the leased employees pursuant to the requirements of RSA 277-B:9, I (i);
   7. (7) A complete description of the employee grievance system required by RSA 277-B:9, I (j);
   8. (8) Letters of good standing from the NH department of employment security and NH department of revenue administration, showing that the applicant has fulfilled the requirements of RSA 277-B:7;
   9. (9) If the applicant is required to hold any additional license issued by a state or federal agency relative to its operations, provide certified copies of the licenses granted;
   10. (10) If the applicant is not a New Hampshire domiciliary, a copy of the applicant’s employee-leasing license or registration issued by its state of domicile, or if no license or registration is issued by that state, then a certificate or letter of good standing;
   11. (11) A written statement explaining how the applicant shall meet the financial assurances required by RSA 277-B:6;
   12. (12) For any applicant domiciled in New Hampshire, a written safety summary of the applicant as required by RSA 281-A:64, II; and
   13. (13) If the applicant is a subsidiary of a parent company, a document signed by the parent company agreeing and guaranteeing the direct payment of benefits if the applicant fails or defaults in its obligation to do so, which agreement shall not be terminated without 60 days’ notice to the commissioner. The parent company shall complete, sign, have the signature acknowledged by a notary public, and file with the commissioner the “Parent Company Agreement” form WC-EMPLSNG-PC Rev. 08/2022.
3. (c) The workers' compensation policy or policies as required in (b)(2) above shall reflect the workers' compensation classification based on the work performed by the employees of the leasing company.
4. (d) The workers' compensation policy or policies as required in (b)(2) above shall comply with RSA 281-A and Lab 100 through Lab 500 rules adopted thereunder.
5. (e) If meeting the requirement of (b)(3) above, the health insurance policy shall be in the name of the applicant and shall be current.

Source. #6626, eff 11-4-97, EXPIRED: 11-4-05 New. #10221, eff 11-3-12, ss by #13440, eff 8-24-22