Form B "Employee Status Change Notification" - New Hampshire

What Is Form B?

This is a legal form that was released by the New Hampshire Department of Safety - 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 February 1, 2017;
  • The latest edition provided by the New Hampshire Department of Safety;
  • 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 B by clicking the link below or browse more documents and templates provided by the New Hampshire Department of Safety.

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Download Form B "Employee Status Change Notification" - New Hampshire

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NEW HAMPSHIRE FIRE STANDARDS AND TRAINING COMMISSION
EMPLOYEE STATUS CHANGE NOTIFICATION
FORM B
Last 4 digits
First name / Middle name / Last name
Date of birth:
of Soc. Sec. #:
(mm/dd/yyyy)
Employee
Employee
phone #:
email address:
Fire Department name:
Fire Department address:
Employee Status Change
Effective Date:
Chief’s Name
Chief’s Phone #:
Chief’s Email Address:
Check ONE of the following:
Discharge:
Retirement:
Resignation:
Death:
Name of Hiring Authority:
Signature of Hiring Authority:
Title:
Date:
This form is required, per Administrative Rules, Chapter 600; Part Fire 601.02:
Notification Requirements of all Appointed Full-Time Career Fire Personnel, Fire Department Notification
of Termination
DIRECTIONS:
This form must be submitted to the Fire Standards and Training
Commission within 15 days of the effective date.
MAILING ADDRESS:
NH Fire Standards and Training Commission
33 Hazen Drive, Concord, NH 03305
FAX NUMBER: 603-271-1091
Form B: Updated 02-2017
NEW HAMPSHIRE FIRE STANDARDS AND TRAINING COMMISSION
EMPLOYEE STATUS CHANGE NOTIFICATION
FORM B
Last 4 digits
First name / Middle name / Last name
Date of birth:
of Soc. Sec. #:
(mm/dd/yyyy)
Employee
Employee
phone #:
email address:
Fire Department name:
Fire Department address:
Employee Status Change
Effective Date:
Chief’s Name
Chief’s Phone #:
Chief’s Email Address:
Check ONE of the following:
Discharge:
Retirement:
Resignation:
Death:
Name of Hiring Authority:
Signature of Hiring Authority:
Title:
Date:
This form is required, per Administrative Rules, Chapter 600; Part Fire 601.02:
Notification Requirements of all Appointed Full-Time Career Fire Personnel, Fire Department Notification
of Termination
DIRECTIONS:
This form must be submitted to the Fire Standards and Training
Commission within 15 days of the effective date.
MAILING ADDRESS:
NH Fire Standards and Training Commission
33 Hazen Drive, Concord, NH 03305
FAX NUMBER: 603-271-1091
Form B: Updated 02-2017