New Jersey Ofce of the Attorney General
Division of Consumer Affairs
New Jersey State Board of Cosmetology and Hairstyling
124 Halsey Street, 6th Floor, P.O. Box 45003
Newark, New Jersey 07101
(973) 504-6400
Application for a Temporary Permit
Important note
If you wish to apply for a Temporary Permit, you must ll out an Application for
Authorization to Sit for the Examination and for Licensure and submit it at the same time
that you submit a completed Application for a Temporary Permit. Both applications
must be submitted together along with the correct fee for each application. A Temporary
Permit will not be issued if the Board does not receive a completed Application for
Authorization to Sit for the Examination and for Licensure at the same time that it
receives a completed Application for a Temporary Permit.
New Jersey Ofce of the Attorney General
Division of Consumer Affairs
New Jersey State Board of Cosmetology and Hairstyling
124 Halsey Street, 6th Floor, P.O. Box 45003
Newark, New Jersey 07101
(973) 504-6400
Application for a Temporary Permit
Indicate the type of Temporary Permit you are applying for:
Cosmetology & Hairstyling Manicuring Skin Care Specialty
Barbering Beauty Culture Hair Braiding
Date:
Note
A temporary permit will be issued only to cosmetology/hairstyling students who have completed 1,200 hours of training, beauty
culture students who have completed 1,100 hours of training, barbering students who have completed 900 hours of training, skin
care students who have completed 600 hours of training and manicuring students who have completed 300 hours of training.
All of these applicants are seeking a temporary permit to work before the next opportunity to sit for the licensing exam. In
addition, a temporary permit will not be issued until the applicant has received authorization from the Board to sit for the next
licensing examination.
A nonrefundable application ling fee of $20.00, 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 application 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 Country
Mr.
1. Name Mrs. ________________________________________________________________ ( _______________________)
Ms.
Last name First name Middle initial Maiden name
2. Address
Home: _____________________________________________________________________________________________
Street address City State ZIP code County
____________________________________ ___________________________________
Telephone number (include area code) E-mail address
Mailing: ____________________________________________________________________________________________
Street or P.O. Box City State ZIP code County
Photo #1
Photo #2
Attach two clear, full-face
passport-style photographs
(2˝x 2˝) of your head and
shoulders, taken within the
past six months.
Two photos are required with
each application.
Staple one photo here and one
in the square to the right.
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.
Education and Training
1. What is the name and address of the high school you attended? _________________________________________________
Name of high school
_______________________________________________________________________________________________________
Street address City State ZIP code
2. How many years of high school have you completed? ______________
3. Have you graduated from high school? Yes No
If “Yes,” what was or will be the date of your graduation? ___________________
Month Year
If “No,” did you study to receive a G.E.D. certicate? Yes No
If “Yes,” please provide the name and address of the educational institution that issued your G.E.D. certicate and
the date
the
certicate was issued.
_______________________________________________________________________________________________________
Name of educational institution
_______________________________________________________________________________________________________
Street address City State ZIP code
___________________________________
Date certicate was issued
4. Have you previously attended a school of cosmetology and hairstyling, manicuring, barbering, skin care specialty, beauty
culture or other vocational school? Yes No
If “Yes,provide the name and address of the school, the dates you attended, and the number of hours you completed there.
_______________________________________________________________________________________________________
Name of school
_______________________________________________________________________________________________________
Street address City State ZIP code
Dates attended: From ________________ To _________________
Did you graduate? Yes No No. hours completed ___________________
5. Provide the name and address of the school where you completed the 1,200-hour cosmetology and hairstyling course, the
1,100-hour beauty culture course, the 900-hour barbering course, the 600-hour skin care course or the 300-hour manicuring
course that is required to obtain a temporary permit.
_______________________________________________________________________________________________________
Name of school
_______________________________________________________________________________________________________
Street address City State ZIP code
Certication of Applicant
I do hereby certify that I am of good moral character. I have been informed of the minimum requirements to obtain a temporary
permit and understand that I must meet those requirements. I further afrm that all statements made by me on this form are true
and accurate and are made for the purpose of making application to the New Jersey State Board of Cosmetology and Hairstyling
for a temporary permit.
Date: ___________________________ , 20 ______ . _______________________________________
Month Day Signature of applicant
Witnessed by:
___________________________________________________________________________________________
Signature of parent or nearest kin of applicant Address ZIP code