Form ST-1 "Application for Service Technician Exam and License" - New Hampshire

What Is Form ST-1?

This is a legal form that was released by the New Hampshire Department of Agriculture, Markets & Food - a government authority operating within New Hampshire. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 10, 2020;
  • The latest edition provided by the New Hampshire Department of Agriculture, Markets & Food;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form ST-1 by clicking the link below or browse more documents and templates provided by the New Hampshire Department of Agriculture, Markets & Food.

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Download Form ST-1 "Application for Service Technician Exam and License" - New Hampshire

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State of New Hampshire
Department of Agriculture, Markets & Food
Division of Weights and Measures
State House Annex Building
Mailing: PO Box 2042, Concord, NH 03302-2042
Physical: 25 Capitol Street, Rm 216, Concord, NH 03301
P: 603-271-3700 F: 603-271-1109 nhwm@agr.nh.gov
www.agriculture.nh.gov
APPLICATION FOR SERVICE TECHNICIAN EXAM AND LICENSE
Pursuant to RSA 438; Agr 1404 and Agr 1405
INSTRUCTIONS
Complete a typed application that is accurate. Applications will not be processed until all requirements are met.
Send the completed application via email or to the mailing address listed above.
Upon receipt of the completed application, the Division will notify the applicant and/or employer via email of the total
amount due for exam and license fees, which depends on scheduled exam date.
Send a non-refundable check or money order to the above mailing address with the correct payment amount made
payable to “Treasurer, State of NH”.
Upon receipt of the payment, the Division will notify the applicant and/or employer via email of the reserved
examination date and applicable exam information.
If you need additional information on the service technician examination and licensing process, see For Service
Technicians on the NH Division of Weights and Measures website at www.agriculture.nh.gov.
APPLICANT INFORMATION
Name:
Last (full)
First (full)
Middle (full)
Mailing Address:
Street
City
State
Zip
Personal Phone #:
Personal Email:
Are you within 30 days of 18 years of age or older? Yes
No
Date of Birth:
MM/DD/YYYY
Drivers License #:
State Issued:
Have you been licensed as a NH Service Technician in the past?
Yes
No
If you answered yes to the previous question, provide the name you used on your license:
First Choice
Second Choice
Third Choice
Indicate your preferred exam dates (reference website for exam listings):
Form: ST-1
Page 1 of 2
NH Division of Weights and Measures
Revised: 2020-Mar-10
State of New Hampshire
Department of Agriculture, Markets & Food
Division of Weights and Measures
State House Annex Building
Mailing: PO Box 2042, Concord, NH 03302-2042
Physical: 25 Capitol Street, Rm 216, Concord, NH 03301
P: 603-271-3700 F: 603-271-1109 nhwm@agr.nh.gov
www.agriculture.nh.gov
APPLICATION FOR SERVICE TECHNICIAN EXAM AND LICENSE
Pursuant to RSA 438; Agr 1404 and Agr 1405
INSTRUCTIONS
Complete a typed application that is accurate. Applications will not be processed until all requirements are met.
Send the completed application via email or to the mailing address listed above.
Upon receipt of the completed application, the Division will notify the applicant and/or employer via email of the total
amount due for exam and license fees, which depends on scheduled exam date.
Send a non-refundable check or money order to the above mailing address with the correct payment amount made
payable to “Treasurer, State of NH”.
Upon receipt of the payment, the Division will notify the applicant and/or employer via email of the reserved
examination date and applicable exam information.
If you need additional information on the service technician examination and licensing process, see For Service
Technicians on the NH Division of Weights and Measures website at www.agriculture.nh.gov.
APPLICANT INFORMATION
Name:
Last (full)
First (full)
Middle (full)
Mailing Address:
Street
City
State
Zip
Personal Phone #:
Personal Email:
Are you within 30 days of 18 years of age or older? Yes
No
Date of Birth:
MM/DD/YYYY
Drivers License #:
State Issued:
Have you been licensed as a NH Service Technician in the past?
Yes
No
If you answered yes to the previous question, provide the name you used on your license:
First Choice
Second Choice
Third Choice
Indicate your preferred exam dates (reference website for exam listings):
Form: ST-1
Page 1 of 2
NH Division of Weights and Measures
Revised: 2020-Mar-10
EMPLOYER INFORMATION
Company Name:
DBA Name:
(If Applicable)
Mailing Address:
Street or PO Box
City
State
Zip
Contact Person:
Phone #:
Fax #:
Email:
DEVICE CATEGORIES
SCALES:
A
30 lbs or less
B
31 to 300 lbs
C
301 to 3000 lbs
D
3001 to 20 000 lbs
E
20 001 and up F
Vehicle Scales G
Analytical Balances
R
Lift Truck Onboard Weighing Systems
RETAIL MOTOR FUEL DEVICES:
H
Gasoline Pumps I
LP Gas Pumps
J
Natural Gas Pumps
LARGE VOLUME:
K
Vehicle Tank Meters L
Bulk Storage Meters M
LPG Vehicle Tank Meters Q
Bulk Motor Oil Meters
OTHER:
N
Taxi Meters
O
Linear & Cordage Measures P
Farm Bulk Milk Tanks
APPLICANT SHALL READ, SIGN, AND DATE:
1) I understand that I shall pass a written examination for the device categories indicated above. 2) I understand that the only test standards to be used shall be
those certified by an accredited laboratory and that I shall submit a certificate of calibration for all test standards used. 3) I certify that I possess the necessary
standards and testing equipment to service the device categories for which I am requesting a license. 4) I certify that I have a current edition of NIST
Handbook 44 and all relevant Examination Procedure Outlines. 5) I certify that I have a current copy of the New Hampshire code of administrative rules,
Agr 1400, and that I shall operate in accordance with these rules. 6) I certify that there are no willful misrepresentations or falsifications in the information
provided above. 7) I understand if an investigation discloses any willful misrepresentations or falsifications my application shall be rejected. 8) If, after
issuance of my service technician license, should an investigation disclose any willful misrepresentations or falsifications, my license shall be suspended and
I shall be subject to penalties under RSA 438:40.
Applicant Signature:
Date:
FOR DIVISION USE ONLY
DATE RECEIVED:
CHECK #:
EXAM FEE:
CERTIFICATE COPY:
DATE RECEIVED:
CHECK #:
SEAL PRESS COPY:
LIC. FEE:
EXAM DATE:
EXAM SCORE:
LIC. #:
Form: ST-1
Page 2 of 2
NH Division of Weights and Measures
Revised: 2020-Mar-10
Page of 2