By signing the EMS I and EMS I/C application form, the applicant shall certify that:
- (a) The information provided in the application is complete, truthful, and correct, under the penalties of unsworn falsification pursuant to RSA 641:3;
- (b) The applicant complies with RSA 153-A and these rules;
- (c) The applicant understands any material falsification of information shall result in license denial, suspension, or revocation, in accordance with Saf-C 5922.03, Saf-C 5922.04, or Saf-C 5922.05 and may be grounds for a misdemeanor conviction pursuant to RSA 641:3;
- (d) The applicant has not been convicted or found guilty of an offense pursuant to RSA 153-A:13, I or Saf-C 5922.03(c)(5);
- (e) The applicant 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 5909.03(b) to Saf-C 5909.03(e) the applicant shall provide official documentation that fully describes the offense, current status, and disposition of the case.
Source. (See Revision Note #1 and Revision Note #2 at Chapter heading for Saf-C 5900) #12790, effective 5-24-19; ss by #13953, eff 4-30-24