The applicant for reinstatement shall supply the following information on the application form “Application For Reinstatement of Certification as a Soil or Wetland Scientist”:

1. (a) The applicant’s full legal name;
2. (b) Any names previously used, if applicable;
3. (c) Date of birth;
4. (d) The license number held in the state of NH;
5. (e) Home mailing address;
6. (f) Home physical address if different from home mailing address;
7. (g) Personal e-mail address;
8. (h) Business name;
9. (i) Business address and telephone number;

10. (j) Answer Yes or no to the following:

    1. (1) “Have you ever been convicted of any felony, misdemeanor, violation involving natural science, or the practice of soil science or wetland science, which has not been annulled or previously reported?”
    2. (2) “Have you ever had a registration or licensed revoked, suspended, denied by any other state or jurisdiction, which has not been previously reported?”
    3. (3) “Have you ever been disciplined or sanctioned by another licensing board in any other state or jurisdiction, which has not been previously reported?”
    4. (4) “Have you obtained 24 hours of continuing education as described in Soil 404 in the immediately preceding 24 months?”

11. (k) Sign and date the form under the following attestations:

    “I acknowledge that knowingly making a false statement on this application form is a misdemeanor under RSA 641:2, I. I certify that the information I have provided on all parts of the application form and in the documents that I have personally submitted to support my application is complete and accurate to the best of my knowledge and belief. I also certify that I have read the statute and the rules of the Board and promise that, if I am certified, I will abide by them.”

Source. #13560, eff 4-7-23