"Employee Leasing Checklist" - New Hampshire

Employee Leasing Checklist is a legal document that was released by the New Hampshire Department of Labor - a government authority operating within New Hampshire.

Form Details:

  • Released on October 9, 2019;
  • The latest edition currently provided by the New Hampshire Department of Labor;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the New Hampshire Department of Labor.

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Employee Leasing Checklist
Send complete packet to:
Attention: Debbie Field
Department of Labor
95 Pleasant Street
Concord, NH 03301
When filing the Employee Leasing Application, please include the following:
Completed and signed application form
A description of the business conducted
Criminal Record Release Authorization Forms for each individual in paragraph 2 of the
application
 The forms and fees must be included with the leasing application when submitted
 You can download the form from the Department of Safety website at:
https://www.nh.gov/safety/divisions/nhsp/jib/crimrecords/index.html
 Person to receive the records: “Debbie Field”
 Make checks payable to: “State of NH – Criminal Records”
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. (Subsidiaries only)
A copy of the applicant’s workers’ compensation policy covering all leased employees of
the applicant
A list of clients with their name, business address, FEIN, number of employees in NH
and name of workers’ compensation carrier
Evidence satisfactory to the commissioner that any health insurance benefits covering
leased employees are provided pursuant to provisions of RSA 277-B:11, II (Example:
Letter stating where health insurance is provide and who the carrier is)
An audited financial statement prepared by an independent Certified Public Accountant
in accordance with generally accepted account principles within twelve (12) months prior
to the date of application which statement shall show a minimum working capital of
$100,000 per RSA 277-B:6, I
Quarterly Tax Certification from a Certified Public Accountant per RSA 277-B:6,III
(Renewals only)
A copy of the employee manual provided to the leased employee outlining the terms and
conditions of employment with the leasing company per RSA 277-B:9, I(i)
Confirmation from home state, if other than NH, that the leasing company is in good
standing
A copy of the applicant’s license issued by its State of domicile or a letter stating the state
does not issue license, if the applicant is not a NH resident or domiciliary
A letter signed by the principle on the application certifying that the applicant does not
conduct a temporary help service through the same entity as the applicant’s employee
leasing company
Letter of Good Standing from the NH Department of Employment Security
Letter of Good Standing from the NH Department of Revenue regarding Business Profit
Tax
A Surety bond in the sum of $100,000
Any open or unpaid Civil Penalties or violations with Coverage Unit or Inspections
Page 1 of 2
Employee Leasing Checklist
Revised 10/9/19
Employee Leasing Checklist
Send complete packet to:
Attention: Debbie Field
Department of Labor
95 Pleasant Street
Concord, NH 03301
When filing the Employee Leasing Application, please include the following:
Completed and signed application form
A description of the business conducted
Criminal Record Release Authorization Forms for each individual in paragraph 2 of the
application
 The forms and fees must be included with the leasing application when submitted
 You can download the form from the Department of Safety website at:
https://www.nh.gov/safety/divisions/nhsp/jib/crimrecords/index.html
 Person to receive the records: “Debbie Field”
 Make checks payable to: “State of NH – Criminal Records”
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. (Subsidiaries only)
A copy of the applicant’s workers’ compensation policy covering all leased employees of
the applicant
A list of clients with their name, business address, FEIN, number of employees in NH
and name of workers’ compensation carrier
Evidence satisfactory to the commissioner that any health insurance benefits covering
leased employees are provided pursuant to provisions of RSA 277-B:11, II (Example:
Letter stating where health insurance is provide and who the carrier is)
An audited financial statement prepared by an independent Certified Public Accountant
in accordance with generally accepted account principles within twelve (12) months prior
to the date of application which statement shall show a minimum working capital of
$100,000 per RSA 277-B:6, I
Quarterly Tax Certification from a Certified Public Accountant per RSA 277-B:6,III
(Renewals only)
A copy of the employee manual provided to the leased employee outlining the terms and
conditions of employment with the leasing company per RSA 277-B:9, I(i)
Confirmation from home state, if other than NH, that the leasing company is in good
standing
A copy of the applicant’s license issued by its State of domicile or a letter stating the state
does not issue license, if the applicant is not a NH resident or domiciliary
A letter signed by the principle on the application certifying that the applicant does not
conduct a temporary help service through the same entity as the applicant’s employee
leasing company
Letter of Good Standing from the NH Department of Employment Security
Letter of Good Standing from the NH Department of Revenue regarding Business Profit
Tax
A Surety bond in the sum of $100,000
Any open or unpaid Civil Penalties or violations with Coverage Unit or Inspections
Page 1 of 2
Employee Leasing Checklist
Revised 10/9/19
Fees:
Payments shall be made payable to: “Treasurer, State of New Hampshire”
Fee applicable to initial and renewal applications
Fees are non-refundable
$100 Filing Fee
License Fee
 One year License Fee
 If domiciled in New Hampshire: $500
 If not domiciled in New Hampshire: $500 or the amount required by the
domiciliary state, whichever is greater
 Two year Licenses Fee
 Only available for renewal applications after five years or more of being
licensed in NH
 If domiciled in New Hampshire: $1,000
 If not domiciled in New Hampshire: $1,000 or the amount required by the
domiciliary state, whichever is greater
For Department of Labor Use
Date Received Application
____________________
Date Reviewed Application ____________________
Date Approved
____________________
License Number
____________________
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Employee Leasing Checklist
Revised 10/9/19
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