Fillable Architect Registration Exam Application for N.J. Licensed Professional (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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Architect Registration Exam Application for N.J. Licensed Professional (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
New Jersey State Board of Architects
124 Halsey Street, 3rd Floor, P.O. Box 45001
Newark, New Jersey 07101
(973) 504-6385
Architect Registration Exam Application for
N.J. Licensed Professional Engineers
Dear Applicant:
Please be advised that your application le must contain the following documents before the Board’s approval:
1. Completed application accompanied by a $50.00 certied check or money order payable to the New Jersey
State Board of Architects, 124 Halsey Street, 3rd Floor, Newark, New Jersey 07102.
2. Certication of a New Jersey professional engineer license sent directly to the Board from the New Jersey State
Board of Professional Engineers and Land Surveyors. Contact the State Board of Professional Engineers and
Land Surveyors at 973-504-6460 and request that the certication be forwarded to the New Jersey State Board
of Architects.
3. College transcripts to be sent directly from the college to the New Jersey State Board of Architects.
All applicants are required to contact NCARB at 202-879-0520 and/or proceed to the my.ncarb.org web link and
establish an NCARB Record.
Furthermore, all exam candidates will be required to follow the Board’s regulation pursuant to:
Subchapter 4. Licensing Requirements: N.J.A.C. 13:27-4.3 -
a) Applicants are required to successfully complete all divisions of the Architect Registration Exam (A.R.E.)
administered by the National Council of Architectural Registration Boards (NCARB).
b) A professional engineer licensed in the State of New Jersey in good standing, holding an accredited degree in
engineering, and without restriction, complaint or charge of illegal practice of architecture, shall be eligible
for licensure as an registered architect upon successful completion of the A.R.E.
Should you have further questions regarding the above, please do not hesitate to contact this ofce at 973-504-6385.
New Jersey Ofce of the Attorney General
Division of Consumer Affairs
New Jersey State Board of Architects
124 Halsey Street, 3rd Floor, P.O. Box 45001
Newark, New Jersey 07101
(973) 504-6385
Application for Registration as an Architect
Date:_____________________________
A nonrefundable Architect Registration Examination application ling fee of $50
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.)Ifyouareregisteredasalicensedarchitectinanotherstateorjurisdiction,
andyouarenowseekinglicensure by credentials in New Jersey, you must submit with this application a nonrefundable
application ling fee of $75.
TheDivisionisprecludedbylawfromdisclosingtothepublictheplaceofresidenceoflicenseesorapplicants,without
theirconsent.Youare,however,requiredtoprovideanaddressthatmaybereleasedtothepublicinourdirectoriesorin
responsetootherrequests(byputtingacheckintheappropriatebox).Ifyouprovideyourplaceofresidenceasyourpublic
addressofrecord,wewillassumethatyouhaveconsentedtohavethataddressbedisclosed.Ifyoudonotconsenttothe
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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 oFFice Use only
Application number:
____________________
3. SocialSecurityNumber
Youmust discloseyourSocialSecuritynumberforthereasonsstatedbelow.Failuretodosomayresultinadenialoflicensureor
certicationorlicenseorcerticaterenewal.
*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)AoftheSocialSecurityActand45C.F.R.60.7,60.8and60.9,theBoardisrequiredtoobtain
yourSocialSecuritynumber.Pursuanttotheseauthorities,theBoard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;
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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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yourlicensureorcertication.
 ___________________________________ ___________________________________ ________________________

Applicant’sname(pleaseprint) Applicant’ssignature Date
6. 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
7. 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. Yes No
If“Yes,”provideacopyofthejudgmentofconvictionandthereleasefromparoleorprobation.Pleaseprovideacompleteexplanation.
(Attachadditionalsheetsofpapertothisapplication.)
8. Doyoucurrentlyhold,orhaveyoueverheld,aprofessionallicenseorcerticateofanykind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.____________________________________________________________________
LastnameFirstname Middleinitial
_____________________ _______________________ ____________________________ ____________________
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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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. Hasanyaction(includingtheassessmentofnesorotherpenalties)everbeentakenagainstyourprofessional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architectureorotherprofessional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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
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group
relatedtothepracticeofarchitectureorotherprofessional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15,is“Yes,”provideacompleteexplanationofthecircumstances
leadingtotheaction,andanysupportingdocumentation,onseparatesheetsofpaper.
Iherebyapplyforregistrationandlicensuretopracticearchitecturebythefollowingmethod:
WrittenLicensingExamination
Licensurebycredentials:N.C.A.R.B.CerticateNo.___________ Stateorjurisdiction___________ RegistrationNo. __________
Licensurebycredentials:N.C.A.R.B.RecordFileNo.__________ Stateorjurisdiction___________ RegistrationNo. __________
Licensurebycredentials:Directlythroughoriginaljurisdiction Stateorjurisdiction___________ RegistrationNo. __________
• Ifyouhavepreviouslyappliedtoanotherstateorjurisdictionforexaminationorlicensure,andhavenotcompletedtheprocessfor
anyreason,identifythestateorjurisdiction:_________________________________Applicationdate:_____________________.
Ifyourapplicationwasrejected,pleaseattachanexplanationtothisapplication.
A. Educational Background
Secondary School
______________________________________________________________________________________
Name of school Dates of attendance (From – To) Grades completed
______________________________________________________________________________________
Name of school Dates of attendance (From – To) Grades completed
______________________________________________________________________________________
Name of school Dates of attendance (From – To) Grades completed
Colleges, Universities, Technical Schools
______________________________________________________________________________________
Name of school (From – To) Dates of attendance/degrees
______________________________________________________________________________________
Name of school (From – To) Dates of attendance/degrees
______________________________________________________________________________________
Name of school (From – To) Dates of attendance/degrees
______________________________________________________________________________________
Name of school (From – To) Dates of attendance/degrees
______________________________________________________________________________________
Name of school (From – To) Dates of attendance/degrees
______________________________________________________________________________________
Name of school (From – To) Dates of attendance/degrees
Travel, Continuing Education, Research, Publications:
B. Professional Organization Service
_________________________________________________________________________________________
Name of organization Name of secretary Address
_________________________________________________________________________________________
Name of organization Name of secretary Address
_________________________________________________________________________________________
Name of organization Name of secretary Address
_________________________________________________________________________________________
Name of organization Name of secretary Address
_________________________________________________________________________________________
Name of organization Name of secretary Address
_________________________________________________________________________________________
Name of organization Name of secretary Address
C. PracticalExperience
Provide the employer’s full name and the firm’s
completeandcurrentaddress.Identifythebusiness
orprofession.Nameyourimmediatesupervisorand
providehisorhertitleandlicensenumber.Beginwith
yourmostrecentexperience,includingmilitaryand
otheroccupations.**
Datesof
employment
Month and Year
From
To
From
To
From
To
From
To
From
To
From
To
From
To
From
To
From
To
From
To
Totaltime
employed
*Part Time
Years
Months
Years
Months
Years
Months
Years
Months
Years
Months
Years
Months
Years
Months
Years
Months
Years
Months
Years
Months
Full Time
Years
Months
Years
Months
Years
Months
Years
Months
Years
Months
Years
Months
Years
Months
Years
Months
Years
Months
Years
Months
CheckAppropriateExperiences
* Ifpart–timeworkisnoted,indicatetheaveragenumberofhoursworkedperweek.
** If“other”kindsofworkarenoted,describethemonaseparatesheetofpaper.
ProgrammingResearch
SchematicDesign
DesignDevelopment
ContractDrawings
Specicationsand
CostEstimating
ContractAdministration
OfceAdministration
StructuralDesign
Mech./Elec.Design
Interior,Landscapeand
UrbanPlanning
TeachinginArch.School
OtherExperiences
D. Public and Community Service
E. Architect
References
Name three architects who are personally acquainted with your professional abilities. Please provide a complete
address for every architect listed.
______________________________________________________________________________________
Name
______________________________________________________________________________________
Street address City State ZIP code
______________________________________________________________________________________
Name
______________________________________________________________________________________
Street address City State ZIP code
______________________________________________________________________________________
Name
______________________________________________________________________________________
Street address City State ZIP code
F. Professional Status
Individual practitioner General partner Limited partner or associate
Corporation director Employee Professional service corporation
_________________________________________________________________________________________
Firm name Years (From - To)
_________________________________________________________________________________________
City State ZIPcode
If you previously have been a principal in an architectural rm, complete the following:
_________________________________________________________________________________________
Firm name Years (From - To)
_________________________________________________________________________________________
City State ZIPcode
_________________________________________________________________________________________
Firm name Years (From - To)
_________________________________________________________________________________________
City State ZIPcode
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NewJerseyStateBoardofArchitects
forlicensureorcerticationundertheprovisionsofTitle45oftheGeneralStatutesofNewJerseyandtheRulesoftheNewJerseyState
BoardofArchitects,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 affirm) that I have read N.J.S.A. 45:3-1 et seq., together with the Rules and Regulations of the
NewJerseyStateBoardofArchitects,N.J.A.C.13:27-1.1etseq.,andfullyunderstandthatinreceivinglicensureorcertication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
__________________________________________________
NameofNotaryPublic(pleaseprint)
__________________________________________________
SignatureofNotaryPublic
AfxSealHere
} ss.
Qualications: Recommendations: BoardAction:
Education Interview Interview Date______________________
Experience AdmitExam Withhold/Deny Date______________________
Examination Certify Certify Date______________________
CerticateorLicenseNo._____________________________ Granted ___________________________________
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Architect Registration Exam Application for N.J. Licensed Professional (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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