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

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

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  • 66 check-boxes
  • 142 other fields

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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 an Alarm License
for Individual Licensed in Another State
(N.J.A.C. 13:31A-1.10)
Instructions to Applicants
General Information
An individual who applies for both a re alarm license and a burglar alarm license must le separate applications. Indicate at
the top of the application whether you are applying for a burglar alarm license or a re alarm license.
The nonrefundable application fee must be paid in the form of a check or money order made payable to the State of New Jersey.
The application fee for the rst alarm license application is $150.00. The application fee for a second alarm license application
is $100.00.
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).
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 burglar alarm or re alarm 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. Not have been convicted of the fourth degree offense of engaging in the unlicensed practice of electrical contracting;
5. Hold a high school diploma or equivalency certicate;
6. Have successfully completed the burglar alarm or re alarm examination, as applicable to the eld in which the applicant
is seeking a license, set forth in N.J.A.C. 13:31A-3.2;
7. Have within the last three years successfully completed:
- Two (2) hours of training in the Barrier Free Subcode, N.J.A.C. 5:23-7
- Two (2) hours of training in the New Jersey Uniform Construction Code, N.J.A.C. 5:23, exclusive of the
Barrier Free Subcode
- Two (2) hours of training in the Americans with Disabilities Act Code, 36 C.F.R. §§ 1191; and
- Two (2) hours of training in industrial safety.
8. Submit verication from all state(s) in which he or she holds a registration, certication or license to engage in the burglar
or re alarm business stating 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
If your application is preliminarily approved, you will undergo a Criminal History Record Background Check.
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. Please fully complete the enclosed Certication and Authorization form and
return the form with the license application. The form must be completed in its entirety, 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 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.
Alarm Licensing Examination
A qualied applicant who has satisfactorily completed the criminal history review will be approved to take an alarm 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 burglar alarm or re alarm 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 Fire and Burglar Alarm 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.
Proof that you have completed the following education within the last three years:
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.
Verication of registration, certication or license in good standing from all states in which you are registered,
certied or licensed.
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 an Alarm License
for Individual 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 City State ZIP code County
Mailing: ___________________________________________________________________________________________
Street or P.O. Box City State ZIP code County
Attach a clear, full-face pass-
port-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: __________________
_______________________
_______________________
Indicate the license you are applying for:
Burglar Alarm License
Fire Alarm License
3. SocialSecurityNumber
IfyouwereissuedaSocialSecurityNumberoranIndividualTaxpayerIdenticationNumber,youmustprovideittothe
BoardorCommittee.Failuretodosomayresultindenialoflicensure/certication/reinstatement/reactivation.
*SocialSecurityNumber: __________-__________-__________
*IndividualTaxpayerIdentication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
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thisinformation.Pursuanttotheseauthorities,theBoardorCommitteeisalsoobligatedtoprovidethis
informationto:
(For healthcare-related boards, the following a, b and c entries apply. For boards not related to healthcare, only the a and
b entries apply.)
 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;
b. theProbationDivisionoranyotheragencyresponsibleforchild-supportenforcement,uponrequest;and
c. theNationalPractitionerDataBankandtheH.I.P.DataBank,whenreportingadverseactionsrelatingtohealth
careprofessionals.
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anAmerican citizen,please encloseacopyof yourbirth certicateor U.S.passport. Ifyouare not
aU.S.citizen,attachacopyofyouralien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statusunderfederallawshouldbedirectedto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documentaryevidencethatyouhavereachedanarrangementwiththebankorwiththeentitythatissued
yourstudentloan,fortheeventualrepaymentoftheloan.Youwillnotbeabletoobtainalicenseorcerticateunlessyouprovidethe
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,”doesthearrearagematchorexceedthetotalamountpayableforthepastsixmonths? Yes No
b. Haveyoufailedtoprovideanycourt-orderedhealthinsurancecoverageduringthepastsixmonths? Yes No
c. Haveyoufailedtorespondtoasubpoenarelatingtoeitherapaternityorchild-supportproceeding? 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throughdmayresultin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
click to sign
signature
click to edit
7. Have you ever been convicted of a criminal offense? (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 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.
_____________________ _______________________ ____________________________ ____________________
Number State or jurisdiction that issued the license or certicate Date issued/expiredType of license or certicate
_____________________ _______________________ ____________________________ ____________________
Number State or jurisdiction that issued the license or certicate Date issued/expiredType of license or certicate
_____________________ _______________________ ____________________________ ____________________
Number State or jurisdiction that issued the license or certicate Date issued/expiredType of license or certicate
_____________________ _______________________ ____________________________ ____________________
Number State or jurisdiction that issued the license or certicate Date issued/expiredType of license or certicate
_____________________ _______________________ ____________________________ ____________________
Date issued/expiredType of license or certicate Number State or jurisdiction that issued the license or certicate
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 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 District of Columbia or in any other jurisdiction? Yes No
11. Has any action (including the assessment of nes or other penalties) ever been taken against your professional or occupational
practice by any agency or certication board in New Jersey, any other state, the District of Columbia or in any other jurisdiction?
Yes No
12. Have you ever been named as a defendant in any litigation related to the practice of re and burglar alarm installation, alteration
and repair or other professional or occupational practice in New Jersey, any other state, 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 sanctioned by or is any action pending before any employer, association, society, or other professional
or occupational group related to the practice of re and burglar alarm installation, alteration and repair 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 9 through 15, is “Yes,” provide a complete explanation of the
circumstances leading to the action, and any supporting documentation, on separate sheets of paper.
___________________________________________________________________
Middle initial Last name First name
Education
An applicant qualifying to take the Alarm Examination must provide proof of having successfully completed, during the
three years immediately preceding 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, 36 C.F.R. Section 1191; and two hours of training
in industrial safety.
Number Date
Title of training Name of provider Location of hours 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
New Jersey Is An Equal Opportunity Employer • Printed on Recycled Paper and Recyclable
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
Alarm - 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 MorphoTrust 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 MorphoTrust; 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 Office 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.
BoardorCommittee
________________________
Ofcial Use Only
Resubmit
________________________
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
Fire Alarm, Burglar Alarm and
Locksmith Advisory Committee
124 Halsey Street, 6th Floor, Newark, NJ 07102
License/Certication/Registration
Verication Request
Direction: Complete only the top portion of this lecense/certication/registration form and forward a copy to every license/
certication/registration agency in the states or jurisdiction 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 for license/certication/registration verication. Please
call the agency to check on any fees that may be required fore license/certication/registration verication prior to submitting
this form.
Applicant
Name: ______________________________________________________________________________________________________
Last name First name Middle initial Maiden name (if applicable)
Name on original license/certication/registration: ________________________________________________________________
Telephone number: ____________________________________ (include area code)
Current address:______________________________________________________________________________________________
Street City State ZIP code
License/Certication/Registration number: __________________________________________Year issued: __________________
Agency
This section is to be completed by the state licensing/certication/registration agency.
1. License/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, suspened 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: ______________________________________
Ofcial seal
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Application for an Alarm 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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