Fillable Application for a Locksmith License for Individual Licensed (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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Application for a Locksmith License for Individual Licensed (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
Fire Alarm, Burglar Alarm and
Locksmith Advisory Committee
124 Halsey Street, 6th Floor, P.O. Box 45042
Newark, New Jersey 07101
(973) 504-6245
www.njconsumeraffairs.gov/fbl
Application for a Locksmith License
for Individual Licensed in Another State
(N.J.A.C. 13:31A-1.10)
Instructions to Applicants
General Information
The application must be neatly printed or typewritten. All sections of the application must be fully completed before the
application can be processed. If the application is not of sufcient size to furnish the required information, a supplemental
sheet of the same size may be enclosed with the application (please refer to the section for which you have used the supplemental
sheet).
The nonrefundable application fee is $150.00 and must be paid in the form of a check or money order made payable to the
State of New Jersey. The application fee is $100.00 if you have applied for a burglar alarm license or a re alarm license.
A full-face photograph, two inches by two inches in size, must be signed and dated on the reverse side and attached to the
application. Do not staple the photograph to the application.
Fully answer all questions with regard to the Criminal History and Child Support sections of the application. Your application
may be delayed or denied should your responses require further review.
The Afdavit section of the application must be executed and signed in the presence of a notary public.
An applicant seeking licensure to engage in the locksmithing business shall:
1. Be at least 18 years of age;
2. Be of good moral character pursuant to N.J.S.A. 45:5A-27;
3. Not have been convicted of a crime of the rst, second or third degree within 10 years prior to the ling of the application for
licensure;
4. Hold a high school diploma or equivalency certicate;
5. Have successfully completed the locksmithing examination set forth in N.J.A.C. 13:31A-2.3;
6. Have within the last three years, successfully completed two hours of training in the New Jersey Uniform Construction
Code, N.J.A.C. 5:23, exclusive of the Barrier Free Subcode, two hours of training in the Americans with Disabilities Act
Code, 36 C.F.R. 1191, and two hours of training in industrial safety; and
7. Submit verication from all states in which he or she holds a registration certication or license to engage in the locksmithing
business showing the registration, certication or license is in good standing.
Your application will be reviewed by the Advisory Committee once you have satised these preliminary requirements.
Criminal History Review
All applicants for a license issued by the Fire Alarm, Burglar Alarm and Locksmith Advisory Committee are required to submit
to a Criminal History Record Background Check. Enclosed with the licensing application is a Certication and Authorization
form and instructions for completing the criminal history review. The form must be fully completed, executed and signed in the
presence of a notary public, and returned to the Advisory Committee ofce with your application for a license. The Advisory
Committee will then provide you with instructions on how to obtain ngerprints. Once your ngerprints have been submitted
to the Criminal History Review Unit, a full review will be performed and a determination will be made regarding your eligibility
to be licensed. An application for licensure will not be processed until the results of the Criminal History Record Background
Check have been reviewed by the Committee.
Locksmith Licensing Examination
A qualied applicant who has satisfactorily completed the criminal history review will be approved to take the locksmith
licensing examination. The applicant will receive an approval letter from the Advisory Committee and a Candidate Information
Bulletin which includes a registration form and instructions about the examination. An applicant must successfully pass all
sections of the examination as a prerequisite to receiving a locksmith license.
Information regarding the burglar alarm and re alarm licensing examinations, including content outlines and subject references,
may be found at www.prometric.com. Once you are at the website, click “Exams by State,” and then click “Burglar/Fire Alarm/
Locksmith License Exams.”
A listing of approved sponsors who provide classes which may be helpful to applicants seeking to obtain alarm and locksmith
licenses is available at our website at www.njconsumeraffairs.gov/fbl.
The Advisory Committee does not require that you take classes from approved sponsors and cannot verify that classes are being
provided to applicants. You may contact a sponsor to inquire whether classes are being provided.
Topic codes:
TECBA - Techinical Burglar Alarm TECFA - Technical Fire Alarm TECBF - Technical Burglar Alarm & Fire Alarm
TECLD - Technical Locks TECES - Electronic Security TECRF - Technical Residential Smoke Detection
L/C - Laws/Codes SAF - Safety BUS - Business
New Jersey Ofce of the Attorney General
Division of Consumer Affairs
Fire Alarm, Burglar Alarm and
Locksmith Advisory Committee
124 Halsey Street, 6th Floor, P.O. Box 45042
Newark, New Jersey 07101
(973) 504-6245
www.njconsumeraffairs.gov/fbl
Applicant for Locksmith License
for Individual Licensed in Another State
(N.J.A.C. 13:31A-1.10)
Submissions Checklist
Applicant:
Please review this checklist before sending in your application. Any materials not included may cause a delay in the processing
of your application.
The application (Please note that every section must be lled out including, but not limited to, child support,
student loans and Social Security number.)
The application fee
One (1) full-face passport size (2”x 2”) photo of your head and shoulders taken within the past six months
The Criminal History Background Check Form (Certication and Authorization)
Citizenship Documentation (if necessary)
The application must be properly executed and notarized.
The applicant must have one of these types of qualications:
Proof that you have completed eight (8) hours of approved technical training, in the three (3) years preceding
the submission of your application, in the following:
Two (2) hours Barrier Free Subcode (N.J.A.C. 5:23-7);
Two (2) hours N.J. Uniform Construction Code, exclusive of the Barrier Free Subcode;
Two (2) hours Americans with Disabilities Act Code, 36 C.F.R. §119; and
Two (2) hours Industrial Safety.
New Jersey Ofce of the Attorney General
Division of Consumer Affairs
Fire Alarm, Burglar Alarm and
Locksmith Advisory Committee
124 Halsey Street, 6th Floor, P.O. Box 45042
Newark, New Jersey 07101
(973) 504-6245
Application for a Locksmith License
for Individual Licensed in Another State
Application date: ________________________
Month Day Year
A nonrefundable application ling fee of $150 in the form of a check or money order made out to the State of New Jersey, must
be submitted with this application. (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 address City State ZIP code County
Mailing: ___________________________________________________________________________________________
Street or P.O. Box City State ZIP code County
Attach a clear, full-face passport-
style photograph (2˝x 2˝) of your
head and shoulders, taken within
the past six months.
A photograph is required with each
application.
Do not use staples to attach the
photograph.
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 may 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. Student Loan
Are you in default in regard to any student loan obligation(s)? Yes No
If “Yes,” you must obtain documentary evidence that you have reached an arrangement with the bank or with the entity that issued
your student loan, for the eventual repayment of the loan. You will not be able to obtain a license unless you provide the
required documents concerning the plan for repayment of your student loan.
6. Child Support (You must answer a, b, c and d.)
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 may 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.
___________________________________ ___________________________________ ________________________
Applicant’s name (please print) Applicant’s signature Date
7. Haveyoueverbeenconvictedofacriminaloffense?Listallcriminaloffensesofwhichtheapplicanthasbeenconvicted,
includingthedateandplaceofeachconvictionandthenameunderwhichheorshewasconvicted,ifotherthanthename
ontheapplication.(Minortrafcoffensessuchasparkingorspeedingviolationsneednotbelisted;however,motorvehicle
offensessuchasdrivingwhileimpairedorintoxicatedmustbedisclosed.) Yes No
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.)
8. Doyoucurrentlyhold,orhaveyoueverheld,aprofessionaloroccupationallicenseorcerticateofanykindinNewJersey,
anyotherstate,theDistrictofColumbiaorinanyotherjurisdiction?   Yes No
If“Yes,”foreachlicenseorcerticateheld,providethedate(s)heldandthenumber(s).Ifthelicenseorcerticatewasissuedunder
adifferentname,pleaseprovidethatname.
_____________________ _______________________ ____________________________ ____________________
Typeoflicenseorcerticate Number Stateorjurisdictionthatissuedthelicenseorcerticate Dateissued/expired
_____________________ _______________________ ____________________________ ____________________
Typeoflicenseorcerticate Number Stateorjurisdictionthatissuedthelicenseorcerticate Dateissued/expired
_____________________ _______________________ ____________________________ ____________________
Typeoflicenseorcerticate Number Stateorjurisdictionthatissuedthelicenseorcerticate Dateissued/expired
_____________________ _______________________ ____________________________ ____________________
Typeoflicenseorcerticate Number Stateorjurisdictionthatissuedthelicenseorcerticate Dateissued/expired
_____________________ _______________________ ____________________________ ____________________
Typeoflicenseorcerticate Number Stateorjurisdictionthatissuedthelicenseorcerticate Dateissued/expired
9. 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
10. 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
11. Haveyoueverbeencitedfordisciplinaryreasonsordeniedaprofessionaloroccupationallicenseorcerticateofanykind
inNewJersey,anyotherstate,theDistrictofColumbiaorinanyotherjurisdiction? Yes  No
12. Haveyoueverbeennamedasadefendantinanylitigationrelatedtothepracticeoflocksmithingorotherprofessionalor
occupationalpracticeinNewJersey,anyotherstate,theDistrictofColumbiaorinanyotherjurisdiction? Yes  No
13. Areyouawareofanyinvestigationpendingagainstaprofessionaloroccupationallicenseorcerticateissuedtoyoubya
certicationboardinNewJersey,anyotherstate,theDistrictofColumbiaorinanyotherjurisdiction? Yes  No
14. 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
15. Haveyoueverbeensanctionedbyorisanyactionpendingbeforeanyemployer,association,society,orotherprofessionalor
occupationalgrouprelatedtothepracticeoflocksmithingorotherprofessionaloroccupationalpracticeinNewJersey,any
otherstate,theDistrictofColumbiaorinanyotherjurisdiction? Yes No
Iftheanswertoanyoftheabovequestions,numbers9through15,is“Yes,”provideacompleteexplanationofthecircumstances
leadingtotheaction,andanysupportingdocumentation,onseparatesheetsofpaper.

  
Training
Having successfully completed, during the three years immediately preceding the submission of this application, two hours
of training in the Barrier Free Subcode, N.J.A.C. 5:23-7, two hours of training in the New Jersey Uniform Construction Code,
N.J.A.C. 5:23, exclusive of the Barrier Free Subcode, two hours of training in the Americans with Disabilities Act Code, 35 C.F.R.
1191 and two hours of training in industrial safety. (Include your certicates of completion with the application.)
a. Title of training _______________________________________________________________________________________
Name of provider _____________________________________________________________________________________
Number of hours ____________________ Date completed ________________________________
b. Title of training _______________________________________________________________________________________
Name of provider _____________________________________________________________________________________
Number of hours ____________________ Date completed ________________________________
c. Title of training _______________________________________________________________________________________
Name of provider _____________________________________________________________________________________
Number of hours ____________________ Date completed ________________________________
d. Title of training _______________________________________________________________________________________
Name of provider _____________________________________________________________________________________
Number of hours ____________________ Date completed ________________________________
e. Title of training _______________________________________________________________________________________
Name of provider _____________________________________________________________________________________
Number of hours ____________________ Date completed ________________________________
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 Fire Alarm, Burglar Alarm and
Locksmith Advisory Committee for licensure or certication under the provisions of Title 45 of the General Statutes of New Jersey
and the Rules of the Fire Alarm, Burglar Alarm and Locksmith Advisory Committee, 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 Committee.
I further swear (or afrm) that I have read N.J.S.A. 45:5A-23 et seq., together with the Rules and Regulations of the
Fire Alarm, Burglar Alarm and Locksmith Advisory Committee, N.J.A.C. 13:31A-3.1 et seq., and fully understand that in receiving
licensure or certication from the Committee, 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 Committee.
_________________________________________________
Signature of applicant
Sworn and subscribed to before me this ________________
day of ____________________________ , ______________
Month Year
__________________________________________________
Name of Notary Public (please print)
__________________________________________________
_ Signature_of_Notary_Public
} ss.
Afx seal here
Locksmith - Important
Certication and Authorization Form
The Division of Consumer Affairs is required to conduct criminal history record background checks of all applicants for burglar
alarm, re alarm and locksmith licensure (N.J.S.A. 45:5A-26 and 35). In order for the Division to conduct a criminal history
record background check, you must complete the enclosed Certication and Authorization Form and return it to:
Fire Alarm, Burglar Alarm and Locksmith Advisory Committee
P.O. Box 45042
Newark, New Jersey 07101
Upon receipt of a completed application form and the Certication and Authorization Form, the Committee will forward to you
information you will need to schedule an appointment to have your ngerprints electronically recorded by Morpho Trust USA.
The recording of your ngerprints is necessary to conduct the criminal history record background check. Please note that you
will be required to pay a $62.70 fee to Morpho Trust; do not send this fee when returning your form to the address above.
If you were ngerprinted after November 2003 as part of the criminal history background process for licensure or certication by
any other Board or Committee of the New Jersey Division of Consumer Affairs (a background check conducted for the Department
of Education, another state agency or another state does not apply) you will not be required to be ngerprinted a second time.
However, the Division must perform a criminal history background check each time you apply for licensure or certication. The
fee for this background check will be $17.50. Payment should be made in the form of a check or money order payable to the
State of New Jersey and should accompany your application packet.
Enclosure
New Jersey Ofce of the Attorney General
Division of Consumer Affairs
Fire Alarm, Burglar Alarm and
Locksmith Advisory Committee
124 Halsey Street, 6th Floor, Newark, NJ 07102
New Jersey Ofce of the Attorney General
Division of Consumer Affairs
Board of Examiners of Electrical Contractors
Fire Alarm, Burglar Alarm and Locksmith Advisory Committee
P.O. Box 45042
Newark, New Jersey 07101
(973) 504-6245
CertifiCAtion And AuthorizAtion form
for A CriminAl history BACkground CheCk
Directions: Answer all of the questions on this form.
1. Name _________________________________________________________ ( _________________________)
Last First Middle Maiden Name
2. Address ___________________________________________________________________________________________
Street or P.O. Box City State ZIP code
3. Date of birth __ __ /__ __ /__ __ Sex: Male Female
Month Day Year
4. Social Security number ________/ _____ / ________
5. Have you completed the ngerprinting process for any Board or Committee of the New Jersey Division of Consumer
Affairs
since November 2003? Yes No
If “No,” you will receive a separate mailing from the Board or Committee regarding the criminal history record
background check process. No payment is necessary as of now.
If “Yes,” please provide the following information and follow the instructions outlined below:
_______________________________________________ _______________________________________________
Board or committee requiring the ngerprinting Month and year you were ngerprinted
If you were ngerprinted after November 2003 as part of the criminal history background process for licensure or
certication by any other Board or Committee of the New Jersey Division of Consumer Affairs (a background check
conducted for the Department of Education, another state agency or another state does not apply) you will not be
required to be ngerprinted a second time. However, the Division must perform a criminal history background check
each time you apply for licensure or certication. The fee for this service is $18.75. Payment should be made in the
form of a check or money order payable to the State of New Jersey and should accompany your application packet.
6. Have you ever been arrested and/or convicted of a crime or offense? (Minor trafc offenses such as a parking or
speeding violations need not be listed.) Yes No
Every such conviction on record must be disclosed. A true copy of every police report, judgment of conviction, sentencing
order and termination of probation order, if applicable, must be submitted with this form. Any documents (including employer
or supervisor letters of reference, if applicable) which present clear and convincing evidence of rehabilitation must be submitted
with this form. Failure to follow these instructions may result in the denial of an initial application.
Note: Copies of judgments, sentencing and termination of probation orders may be obtained from the clerk of the county
where those orders, disposing of the conviction, were issued and led.
Your continuing responsibility to disclose convictions of crimes or offenses: You must notify the Board or Committee
within ve (5) business days if you are convicted of any crimes or offenses after this form has been completed.
Continuation on the reverse side ➨
Mr.
Mrs.
Ms.
Ofcial Use Only
Resubmit
_______________________
Board or Committee
_______________________
Ofcial Use Only
Dual License
License Type 1
_______________________
Applicant’s Number
_______________________
License Type 2
_______________________
Applicant’s Number
_______________________
CertifiCAtion
I, ______________________________________________, in making this application to the Board or Committee for
certication or licensure, certify that I am the applicant and that all of the 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 certication or licensure or to withhold renewal of or suspend or
revoke a certicate or license issued by the Board or Committee.
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 certication or licensure. 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 or Committee.
I certify that the foregoing statements made by me are true. I am aware that if any of the foregoing statements made by
me are willfully false, I am subject to punishment.
________________________________________________________ _________________________________
Signature of applicant Date
Rev. 1/2/19
New Jersey Ofce of the Attorney General
Division of Consumer Affairs
Board of Examiners of Electrical Contractors
Fire Alarm, Burglar Alarm and Locksmith Advisory Committee
P.O. Box 45042
Newark, New Jersey 07101
(973) 504-6245
License/Certication/Registration
Verication Request
Direction: Complete only the top portion of this license/certication/registration form and forward a copy to every license/
certication/registration agency in the states or jurisdictions in which you are or have been licensed/certied/registered. The
agency should complete the form and return it to the Fire Alarm, Burglar Alarm and Locksmith Advisory Committee.
Note: Be advised that the agency completing the form may charge a fee to license/certication/registration verication. Please
call the agency to check on any fees that may be required for license/certication/registration verication prior to submitting
this form.
Applicant
Name: ______________________________________________________________________________________________________
First name Last name Middle initial Maiden name (if applicable)
Name on original license/certication/registration: ________________________________________________________________
First name Last name Middle initial
Current address:______________________________________________________________________________________________
Street address City State ZIP code
Telephone number: _________________________________ (include area code)
License/Certication/Registration number: ___________________________________________Year issued: __________________
State licensing/certication/registration agency
1. Licensing/Certication/Registration number: _____________________________________Date issued: __________________
2. When was the license/certicate/registration last renewed? _________________________
3. Is the license/certicate/registration in good standing? Yes No
4. Has this license/certication/registration ever been revoked, suspended or voluntarily surrendered or has any action been
taken by your agency against this licensee? Yes No
If “Yes,” please provide a description of the reason and/or charge(s) and any action(s) taken and provide a copy of any
complaint, order or relevant document.
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
I certify that the statements contained herein are true based upon ofcial records that
I reviewed.
Print name ______________________________________________________________
Signature________________________________________________________________
Title ____________________________________________________________________
State __________________________________ Date ____________________________
OFFICIAL SEAL
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Application for a Locksmith License for Individual Licensed (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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