Fillable Air Conditioning and Refrigeration (HVACR) Contractor Instructions for (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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Air Conditioning and Refrigeration (HVACR) Contractor Instructions for (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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New Jersey Ofce of the Attorney General
Division of Consumer Affairs
State Board of Examiners of Heating, Ventilating,
Air Conditioning and Refrigeration (HVACR) Contractors
124 Halsey Street, 6th Floor, P.O. Box 47031
Newark, New Jersey 07101
(973) 504-6420
Instructions for Reinstating a License as a Master Heating, Ventilating,
Air Conditioning and Refrigeration (HVACR) Contractor
Pursuant to N.J.A.C. 13:32A-3.3 License Reinstatement
A person who has had his or her license suspended pursuant to N.J.A.C.13:32A-3.1(f) may apply to the Board for
reinstatement. A person applying for reinstatement shall submit:
1) A reinstatement application, attached;
2) A certication of employment listing each job held during the period of suspended license which includes
the names, addresses, and telephone number of each employer;
3) The $160.00 renewal fee set forth in N.J.A.C. 13:32A-6.1 for the biennial period for which reinstatement
is sought;
4) The past due renewal fee $160.00 for the biennial period immediately preceding the renewal period for which
reinstatement is sought;
5) The $150.00 reinstatement fee set forth in N.J.A.C. 13:32A-6.1;
6) Evidence of having completed all continuing education credits for the current biennial registration period,
consistent with the requirements set forth in N.J.A.C. 13:32A-4.1.
Enclose with your completed application:
Please review and submit the following items required for your HVACR license, pursuant to N.J.A.C. 13:32A-2.4
Licensure and pressure seal:
• A surety bond in the sum of $3,000, to expire June 30, 2020;
• A certicate of general liability insurance from an insurance company authorized and licensed to do
business in New Jersey in the amount of $500,000 for combined property damage and bodily injury to or
death of one or more persons in any one accident or occurrence or proof of self-insurance approved by the
Department of Banking and Insurance, obtained by the applicant or the HVACR company or corporation,
only if the applicant will offer HVACR contracting services to the public, which includes instances when the
applicant will act as a bona de representative for a company or corporation;
• A Federal Tax Identication number for the HVACR business if the licensee will be engaging in the
business of HVACR contracting, which includes instances when the applicant will act as a bona de
representative for a company or corporation;
Licensing Fees:
Pursuant to N.J.A.C 13:32A-6.1 Fee Schedule
The following fees shall be charged by the Board. Enclose a Personal Check or Money Order:
Licensure Reinstatement Fee
Year License Lapsed Total Fee Due
The fees are calculated based on the fee for each biennial
cycle that has occurred since the license has lapsed, plus a
reinstatement fee of $150.00 which is already included in the
total fee due noted above.
2016 $470.00
2018 $310.00
Pursuant to N.J.A.C. 13:32A-4.1 License Renewal; Continuing Education Requirement
Every master HVACR contractor shall successfully complete ve credits of continuing education at an approved
course every biennial period.
• Certicate(s) of Completion for Continuing Education - submit proof that you have completed the mandatory
ve (5) hours of continuing education required for the most current biennial cycle for which you are
seeking reinstatement.
Pursuant to N.J.A.C. 13:32A-5.2 Bona Fide Representative; Reporting Responsibilities
A master HVACR contractor seeking to act as a bona de representative shall comply with the following:
1) Register with the Board, providing the name of the HVACR business, its address and if the HVACR business
is a corporation, the names of the ofcers of record, attached;
2) Provide to the Board proof that the HVACR business has consented that the bona de representative will
act as the agent for service of process within this State. Such proof shall be in writing and on a form provided
by the Board, attached;
3) Provide to the Board the acceptance of liability by the HVACR business for any monetary penalty, monies to
be paid for restoration to consumers of fees paid for services or for delays suffered by consumers, and costs
assessed against the bona de representative while acting within the scope of his or her employment on
behalf of the HVACR business. Such acceptance of liability shall be in writing and on a form provided by the
Board, attached.
Submit all documents to: State Board of Examiners of Heating, Ventilating, Air Conditioning
and Refrigeration (HVACR) Contractors
P.O. Box 47031
Newark, NJ 07101
New Jersey Ofce of the Attorney General
Division of Consumer Affairs
State Board of Examiners of Heating, Ventilating,
Air Conditioning and Refrigeration (HVACR) Contractors
124 Halsey Street, 6th Floor, P.O. Box 47031
Newark, New Jersey 07101
(973) 504-6420
Application for Reinstatement of a License to Practice as a Master
Heating, Ventilating, Air Conditioning and Refrigeration (HVACR) Contractor
Application date: ______________________ License number: ______________________________
Month Day Year
Along with the submission of this completed application, all fees must be paid in the form of a check or money order made out
to the State of New Jersey. (Applicants should understand that if the application ling fee is paid with a personal check, and the
check is returned by the bank due to insufcient funds, the next step in the licensure or certication process will be delayed until
the fee is paid.)
The Division is precluded by law from disclosing to the public the place of residence of licensees or applicants, without their
consent. However, you are required to provide an address that may be released to the public in our directories or in response to
other requests (by putting a check in the appropriate box). If you provide your place of residence as your public address
of record, we will assume that you have consented to have that address be disclosed. If you do not consent to the disclosure of
your place of residence, you should provide an address of record other than your place of residence that may be released
to the public. One of your addresses must include a street, city, state and ZIP code.
Information that you provide on this application may be subject to public disclosure as required by the Open Public Records Act
(OPRA).
Please print clearly. You must answer all of the questions on this application.
Personal Information Date of birth: _________________________
Month Day Year
Place of birth: ________________________
City State
Mr.
1. Name Mrs. ________________________________________________________________ ( _______________________)
Ms.
Last name First name Middle initial Maiden name
2. Address
Home: ______________________________________________________________________________________________
Street or P.O. Box City State ZIP code County
_____________________________________ ___________________________________
Telephone number (include area code) E-mail address
Business: ____________________________________________________________________________________________
Name of company Telephone number (include area code)
____________________________________________________________________________________________
Street City State ZIP code County
Mailing: ____________________________________________________________________________________________
Street or P.O. Box City State ZIP code County
For Ofce Use Only
Approved
By _________________
Date __________________
Rejected
By ____________________
Date __________________
Reason ________________
________________________
3. Social Security Number
You must provide your Social Security number to the Board or Committee. Failure to do so will result in denial/nonrenewal of
licensure or certication.
*Social Security Number: __________ -____________ - ___________
*Pursuant to N.J.S.A. 54:50-24 et seq. of the New Jersey taxation law, N.J.S.A. 2A:17-56.44e of the New Jersey Child Support
Enforcement Law, Section 1128E(b)(2)A of the Social Security Act and 45 C.F.R. 60.7,60.8 and 60.9, the Board or Committee is
required to obtain your Social Security number. Pursuant to these authorities, the Board or Committee is also obligated to provide
your Social Security number to:
a. the Director of Taxation to assist in the administration and enforcement of any tax law, including for the purpose of reviewing
compliance with State tax law and updating and correcting tax records; and
b. the Probation Division or any other agency responsible for child-support enforcement, upon request.
4. Citizenship / Immigration Status
Federal law limits the issuance or renewal of professional or occupational licenses or certicates to U.S. citizens or qualied aliens.
To comply with this federal law, check the appropriate box below which indicates your citizenship/immigration status. If you are not
a U.S. citizen, attach a copy of your alien registration card (front and back) or other documentation issued by the ofce of U.S.
Citizenship and Immigration Services (USCIS).
U.S. citizen
Alien lawfully admitted for permanent residence in U.S.
Other immigration status
Questions about your immigration status and whether or not it is a qualifying status under federal law should be directed to the
USCIS at: 1-800-375-5283.
5. Child Support
Please certify, under penalty of perjury, the following:
a. Do you currently have a child-support obligation? Yes No
(1) If “Yes,” are you in arrears in payment of said obligation? Yes No
(2) If “Yes,” does the arrearage match or exceed the total amount payable for the past six months? Yes No
b. Have you failed to provide any court-ordered health insurance coverage during the past six months? Yes No
c. Have you failed to respond to a subpoena relating to either a paternity or child-support proceeding? Yes No
d. Are you the subject of a child-support-related arrest warrant? Yes No
In accordance with N.J.S.A. 2A:17-56.44d, an answer of “Yes” to any of the questions a(1) through d will result in a denial of
licensure or certication. Furthermore, any false certication of the above may subject you to a penalty, including, but not limited
to, immediate revocation or suspension of licensure or certication.
___________________________________ ___________________________________ ________________________
Applicant’s name (please print) Applicant’s signature Date
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signature
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6. Have you ever changed your name? Yes No
If “Yes,” please submit with this application a copy of the marriage certicate, divorce decree or court order.
7. Have you ever been summoned; arrested; taken into custody; indicted; tried; charged with; admitted into pre-trial intervention
(P.T.I.); or pled guilty to any violation of law, ordinance, felony, misdemeanor or disorderly persons offense, in New Jersey, any other
state, the District of Columbia or in any other jurisdiction? (Parking or speeding violations need not be disclosed, but motor vehicle
violations such as driving while impaired or intoxicated must be.) Yes No
Yes No
Have you ever been convicted of any crime or offense under any circumstances? This includes, but is not limited to, a plea of guilty,
non vult, nolo contendere, no contest, or a nding of guilt by a judge or jury.
8.
If “Yes,” provide a copy of the judgment of conviction and the release from parole or probation. Please provide a complete
explanation. (Attach additional sheets of paper to this application.)
9. Do you currently hold, or have you ever held a professional or occupational license or certicate of any kind in New Jersey, any other state, the
District of Columbia or in any other jurisdiction? Yes No
If “Yes,” for each license or certicate held, provide the date(s) held and the number(s). If the license or certicate was issued under
a different name, please provide that name. ____________________________________________________________________
First name Last name Middle initial
_____________________ _______________________ ____________________________ ____________________
Number State or jurisdiction that issued the license or certicateType of license or certicate Date issued/expired
_____________________ _______________________ ____________________________ ____________________
Number State or jurisdiction that issued the license or certicateType of license or certicate Date issued/expired
_____________________ _______________________ ____________________________ ____________________
Number State or jurisdiction that issued the license or certicateType of license or certicate Date issued/expired
_____________________ _______________________ ____________________________ ____________________
Number State or jurisdiction that issued the license or certicateType of license or certicate Date issued/expired
10. Have you ever been disciplined or denied a professional or occupational license or certicate of any kind in New Jersey, any other
state, the District of Columbia or in any other jurisdiction? Yes No
11. Have you ever had a professional or occupational license or certicate of any type suspended, revoked or surrendered in New Jersey,
any other state, the District of Columbia or in any other jurisdiction? Yes No
12. Has any action (including the assessment of nes or other penalties) ever been taken against your professional or occupational
practice by any agency or certication board in New Jersey, any other state, the District of Columbia or in any other jurisdiction?
Yes No
13. Have you ever been named as a defendant in any litigation related to the practice of HVACR contractors or other
professional or occupational practice in New Jersey, any other state, the District of Columbia or in any other jurisdiction?
Yes No
14. Are you aware of any investigation pending against a professional or occupational license or certicate issued to you by a
professional board in New Jersey, any other state, the District of Columbia or in any other jurisdiction? Yes No
15. Are there any criminal charges now pending against you in New Jersey, any other state, the District of Columbia or in any other
jurisdiction? Yes No
16. Have you ever been sanctioned by or is any action pending before any employer, association, society, or other professional or
occupational group related to the practice of HVACR contractors or other professional or occupational practice in New Jersey, any
other state, the District of Columbia or in any other jurisdiction? Yes No
If the answer to any of the above questions, numbers 10 through 16, is “Yes,” provide a complete explanation of the circumstances
leading to the action, and any supporting documentation, on separate sheets of paper.
Employment since your license expired. (You may photocopy this page if necessary.)
Employer’s name: ____________________________________________________________________________________________
Employer’s address: __________________________________________________________________________________________
Street
____________________________________________________________________________________________________________
City State ZIP code
Immediate supervisor’s name: __________________________________________________________________________________
Employer’s telephone number:_______________________________ Hours per week: ___________________________________
(Include area code)
Your major responsibilities (use additional sheets of paper if necessary): ______________________________________________
_________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________
Dates employed: from: __________________________ to: __________________________
month day year month day year
Employer’s name: ____________________________________________________________________________________________
Employer’s address: __________________________________________________________________________________________
Street
____________________________________________________________________________________________________________
City State ZIP code
Immediate supervisor’s name: __________________________________________________________________________________
Employer’s telephone number:_______________________________ Hours per week: ___________________________________
(Include area code)
Your major responsibilities (use additional sheets of paper if necessary): ______________________________________________
_________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________
Dates employed: from: __________________________ to: __________________________
month day year month day year
Employer’s name: ____________________________________________________________________________________________
Employer’s address: __________________________________________________________________________________________
Street
____________________________________________________________________________________________________________
City State ZIP code
Immediate supervisor’s name: __________________________________________________________________________________
Employer’s telephone number:_______________________________ Hours per week: ___________________________________
(Include area code)
Your major responsibilities (use additional sheets of paper if necessary): ______________________________________________
_________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________
Dates employed: from: __________________________ to: __________________________
month day year month day year
_________________________________________ ________________________________________ ______________________
Applicant’s name (Please print) Applicant’s signature Date
Yes
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signature
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Continuing Education Credits Earned
Individuals applying to reinstate a license as a master plumber are required to show that they have completed ve (5) credit
hours of continuing education. Submit copies of all continuing education certicates earned along with this application.
Date of course Name of sponsor Title of program Number of credits
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
AffidAvit
This afdavit is to be executed by the applicant before a notary public:
State of: _____________________________________________
County of: ___________________________________________
I, ___________________________________________ , in making this application to the State Board of Examiners of
Heating, Ventilating, Air Conditioning and Refrigeration (HVACR) Contractors for licensure or certication under the
provisions of Title 45 of the General Statutes of New Jersey and the Rules of the State Board of Examiners of Heating,
Ventilating, Air Conditioning and Refrigeration (HVACR) Contractors, swear (or afrm) that I am the applicant and that all
information provided in connection with this application is true to the best of my knowledge and belief. I understand that
any omissions, inaccuracies or failure to make full disclosures may be deemed sufcient to deny licensure or certication
or to withhold renewal of or suspend or revoke a license or certicate issued by the Board.
I further swear (or afrm) that I have read N.J.S.A. 45:16A-1 et seq., together with the Rules and Regulations of the State
Board of Examiners of Heating, Ventilating, Air Conditioning and Refrigeration (HVACR) Contractors, N.J.A.C. 13:32A-1
et seq., and fully understand that in receiving licensure from the Board, I bind myself to be governed by them.
Furthermore, I voluntarily consent to a thorough investigation of my present and past employment and other activities for the
purpose of verifying my qualications for licensure or certication. I further authorize all institutions, employers, agencies
and all governmental agencies and instrumentalities (local, state, federal or foreign) to release any information, les or
records requested by the Board.
_____________________________________________
Signature of applicant
Sworn and subscribed to before me this _____________
day of _________________________ , ____________
Month Year
Afx Seal Here
_____________________________________________
Name of Notary Public (please print)
_____________________________________________
Signature of Notary Public
} ss.
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New Jersey Ofce of the Attorney General
Division of Consumer Affairs
State Board of Examiners of Heating, Ventilating,
Air Conditioning and Refrigeration (HVACR) Contractors
124 Halsey Street, 6th Floor, P.O. Box 47031
Newark, New Jersey 07101
(973) 504-6420
Registration of Bona Fide Representative
Select category: Initial submission Change to business
License number: ___________________________
Licensed Master HVACR Contractor
Name: ______________________________________________________________________________________
Last name First name Middle name
Address of record: ____________________________________________________________________________
(Available to the public) Street address City State ZIP code
Home Address: ______________________________________________________________________________
Street address City State ZIP code
Home telephone number: _____________________________Cellular number: ____________________________
(include area code) (include area code)
Email address: ________________________________________________________________________________
Mailing Address: ______________________________________________________________________________
Street address City State ZIP code
HVACR Business
Business Name: ______________________________________________________________________________
New Jersey Business Address: ___________________________________________________________________
Street address City State ZIP code
If you do not have a New Jersey address, please identify the New Jersey agent for service of process pursuant to
N.J.A.C. 13:32A-5.3(a)6.
Business telephone number: _____________________________ Fax number: _____________________________
(include area code) (include area code)
In order to register as a bona de representative, you must be a licensed Master HVACR Contractor who
(Select category):
In the case of a sole proprietorship, is the owner of the business;
In the case of a partnership, is a partner in the business;
In the case of a limited liability company, is a manager; or
In the case of a corporation, is an executive ofcer.
Name the Ofcers(s) of Record for Corporation (if applicable):
_____________________________________________ ____________________________________________
_____________________________________________ ____________________________________________
_____________________________________________ ____________________________________________
_____________________________________________ ____________________________________________
N.J.A.C. 13:32A-5.2 (a)2 Bona Fide Representative; Reporting Responsibilities requires proof that the HVACR
business has consented that the bona de representative will act as the agent for service of process within this State.
Signature of licensee _______________________________
N.J.A.C. 13:32A-5.2 (a)3 Bona Fide Representative; Reporting Responsibilities requires proof of the acceptance
of liability by the HVACR business for any monetary penalty, monies to be paid for restoration to consumers of fees
paid for services or for delays suffered by consumers and costs assessed against the bona de representative, while
acting within the scope of his or her employment on behalf of the HVACR business.
Signature of licensee _______________________________
- 2 -
AFFIDAVIT
This afdavit is to be executed by the licensee before a notary public:
State of: _____________________________
County of :___________________________
I, _________________________________________________________________________________________,
(Licensed Master HVACR Contractor)
in submitting this registration to the State Board of Examiners of Heating, Ventilating, Air Conditioning and
Refrigeration (HVACR) Contractors under the provisions of Title 45 of the General Statutes of New Jersey and
the Rules of the State Board of Examiners of Heating, Ventilating, Air Conditioning and Refrigeration (HVACR)
Contractors, do swear or afrm that I am the licensee, and that all of the information provided in connection with this
registration is true to the best of my knowledge and belief. I understand that any omissions, inaccuracies, or failure
to make full disclosures may be deemed sufcient to deny registration.
I further swear or afrm that I have read N.J.S.A. 45:16A-1 et seq. together with the Rules and Regulations of
the State Board of Examiners of Heating, Ventilating, Air Conditioning and Refrigeration (HVACR) Contractors,
N.J.A.C. 13:32A, and fully understand that in registering as a bona de representative, I bind myself to be governed
by them.
I further authorize all institutions, employers, agencies and all governmental agencies, including federal, state or
local government, to release any information as requested by the Board. I may be required at any time to provide tax
documentation upon Board request.
______________________________________
Signature of licensee
Sworn and subscribed to before me this _____
day of ________________________ 20 ____
month year
_____________________________________
Name of Notary Public (please print)
_____________________________________
Signature of Notary Public
- 3 -
} ss.
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Air Conditioning and Refrigeration (HVACR) Contractor Instructions for (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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Completed 14 August 2020

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