WC-EMPLSNG-Renewal Page1 of 3 Revised: 2/9/2016
STATE OF NEW HAMPSHIRE
DEPARTMENT OF LABOR
CONCORD, NH 03301
EMPLOYEE LEASING RENEWAL APPLICATION
Filing Fee: $100.00
Name of Applicant: ___________________________________ Date: _________________
Address:___________________________________________________________________
__________________________________________________________________________
Federal Identification Number: _________________________________________________
Affiliated Companies (if any):
Please list the name and business address of all principals, owners, shareholders, partners,
officers, managers or persons and entities who own 10% or more of the applicant:
Please provide a description of the business(es) operated by the principles, owners,
shareholders, partners, officers, managers or individuals exercising the power to control the
day to day operation or direction of the applicant during the five years immediately
preceding the date of application:
Resume Templates 1210 Document(s)
