Fillable Form 170: -0170 -6500 ext. 5014 609-292-4400 (The State of New Jersey)

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Form 170: -0170 -6500 ext. 5014 609-292-4400 (The State of New Jersey)

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Business Licensing Services Bureau
P.O. Box
170
Trenton, New Jersey 08666
-0170
(609) 292
-6500 ext. 5014
FAX#
609-292-4400
mvcblsprocessing@mvc.nj.gov
STATE OF NEW JERSEY
Announcement
All Initial Individual License Applicants
The New Jersey Motor Vehicle Commission, Business Licensing Services Bureau (BLS) is pleased to
announce that beginning July 10, 2017; BLS will discontinue the practice of requiring an up-front application
fees with the submission of an initial individual license application for the following license privileges:
Driving School Initial Instructor
Driving School Authorized Agent
Probationary Driver Program Instructor (“PDP”)
Driver Improvement Program Instructor (“DIP”)
This change will bring greater efficiency, recording and accounting for all initial application funds and reduce
the risk of lost payments.
A notification requesting payment for the license will be sent after preliminary approval of all licensing
requirements. Your license will be mailed or delivered to the driving school once your payment is processed.
Your compliance with this policy is greatly appreciated. For further information on the initial licensing process,
call 609 292-6500 x5014.
On the Road to Excellence
Visit us at www.njmvc.gov
New Jersey is an Equal Opportunity Employer
New Jersey
Motor Vehicle Commission
New Jersey
Motor Vehicle Commission
STATE OF NEW JERSEY
Business Licensing Services Bureau
P.O. Box 168, Trenton, NJ 08666-0168
609-292-6500 ext. 5094
F
EE:
$75.00
D.L. Check Instructor License Number
Expires
T
o be submitted to Motor Vehicle Services for the purpose of securing approval to engage in motor
vehicle driving instructions by an owner, officer or employee (full or part-time) in connection with a
driving school license pursuant to the provisions
of 39:12 R.S.
ALL APPLICANTS ARE REQUIRED TO PASS A KNOWLEDGE TEST, VISION TEST, DRIVING
INSTRUCTION TEST AND JUDGMENT OF DRIVING ABILITY TEST GIVEN BY MOTOR VEHICLE
SERVICES, AND ARE REQUIRED TO SUBMIT TO FINGERPRINTING.
The Instructor applicant will complete both sides of this application.
Da
te
P
rint Name Telephone No.
Resident Address
(Street) (City) (State) (Zip Code)
PERSONAL DESCRIPTION:
Date of Birth Weight Height Color Eyes
Any Permanent physical marks? Yes No
If
so,
describe
Do you possess a current N.J. Driver’s License? Yes No
N.J. Dr
iver License No.
Expiration Date
Have you held a N.J. Driver
License
for the last four
consecutive
years? Yes No
If no, give residence address in state where you were previously licensed
NOTE: You must submit a certified abstract
of your driving record if the state of licensure is
other than New Jersey, and a copy of your Drivers License.
Has yo
ur driver license privilege ever been suspended or revoked in this or any other state?
Yes No If yes, give particulars
Na
me
of Driving School
Address
of Driving School
(Street) (City) (State) (Zip Code)
State your position with driving school. Owner Partner Officer Employee
BLC
-84
(R 8/15)
DRIVING SCHOOL - INITIAL INSTRUCTORS LICENSE APPLICATION
Have you ever applied for a Driving School Instructor License, or Driving School License in this
or any other state? Yes No
Have you ever been denied a driver’s license, a driving instructor license or a driving school
license in this or any other state?
Yes No
If yes, give particulars
Have you ever been convicted of inducing another to resort to fraud or fraudulent practices in
relation to securing a license to drive a motor vehicle or motorcycle? Yes No
If yes, give particulars
Have you ever been arrested for, charged with, indicted for or convicted of any of the offenses
enumerated in 13:23-2.12? Yes No If yes, give particulars
CIVIL AND FEDERAL OFFENSE HISTORY (INCLUDING COURT
MARTIAL) (RECORD ALL ARRESTS AND CONVICTIONS)
Date Offense Court Disposition Penalty
I
,
THE UNDERSIGNED, DECLARE THAT
I
AM THE APPLICANT NAMED HEREIN, KNOW THE
CONTENTS OF THIS APPLICATION, AND CERTIFY THE CONTENTS HEREIN TO BE TRUE.
(Signature of Applicant) (Date)
S
CHOOL
OWNER’S STATEMENT OF CONSENT
I
am the owner, or partner or officer of the Driving School listed herein, and believing the
information given herein is true, hereby endorse consent in the issuing of an instructor license to
the applicant.
(Signature)
(Title)
(Date)
Initial instructor applicants are required to submit to tests prescribed by the Chief
Administrator to determine that they possess the minimum qualifications for licensing.
BLC-84
(R 8/15)
Business Licensing Services Bureau
P.O. Box 172, Trenton, NJ 08666-017
2
(888) 486-3339 ext. 5014 toll-
free in NJ
609-292-
6500 ext. 5014
mvcblscorrespondence@dot.state.
nj.us
STATE OF NEW JERSEY
Fingerprint Request Notification
In accordance to regulatory requirements, it is mandated that all persons identified in
the initial business application (proprietors, partners, corporate officers, applicants,
providers, instructors and driving school authorized agents) undergo a live scan
criminal background check by the state approved vendor. Submission of your initial
business application authorizes the Commission’s Business Licensing Bureau to
request and receive criminal background check results.
U
pon receipt of this notification, each person identified will be mailed a fingerprint
application and instructional sheet. Once fingerprinted, the receipt and fingerprint
application for each person listed must be forwarded to MVC, as proof of
completion. The processing of your business application will not begin until all
receipts are received.
Complete the attached Fingerprint Request Notification Form listing each person
identified in the business application. If an e-mail address is provided, the
documents will be e-mailed to those individuals, otherwise it will be mailed.
New Jersey
Motor Vehicle Commission
BLS-163 R
-1/18
Business Licensing Services Bureau
P.O. Box 17
2, Trenton, NJ 08666-0172
(888) 486
-3339 ext. 5014 toll-free in NJ
609
-292-6500 ext. 5014
mvcblscorrespondence
@dot.state.nj.us
STATE OF NEW JERSEY
Fingerprint Request Notification Form
Business Name: _____________________________________ Date: __________
Clearly PRINT the following information for all persons identified in the initial business application
( all proprietors, partners, corporate officers, applicants, providers, instructors and driving school
authorized agents)
Applicant Full Name: ____________________________________________________________
Street Address: _________________________________________________________________
City:____________________________________________ State: ______ Zip: ___________
Phone Number: __________________________________
E-Mail Address: __________________________________
_____________________________________
Applicant Full Name: ____________________________________________________________
Street Address: _________________________________________________________________
City:____________________________________________ State: ______ Zip: ___________
Phone Number: __________________________________
E-Mail Address: __________________________________
Applicant Full Name: ____________________________________________________________
Street Address: _________________________________________________________________
City:____________________________________________ State: ______ Zip: ___________
Phone Number: __________________________________
E-Mail Address: __________________________________
Copy and submit additional sheets if needed
New Jersey
Motor Vehicle Commission
BLS-163 R-1/18
On the Road to Excellence
www.njmvc.gov
N
ew Jersey is an Equal Opportunity Employer
_______________________________________________________________________________________
STATE OF NEW JERSEY
Business Licensing Services Bureau
CHILD SUPPORT CERTIFICATION FORM
________________________________________________________________
Business Name
____
_____________________________________ __________________
Applicant’s Name (Print) Date of Birth
____
_____________________________________
Social Security Number
*You must disclose your social security number to the NJMVC. Failure to do so may result in denial/non-renewal of licensure.
Pursuant to N.J.S.A. 54:50-25 et seq. of the New Jersey taxation law and N.J.S.A. 2A:17-56.7a, N.J.S.A. 2A :17-56.60 et seq. of New Jersey Child
Support Program Improvement Act, the licensing agency to which this form is submitted is required to obtain your Social Security number. Pursuant
to these authorities, the licensing agency 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, updating, and correcting tax records;
and
b. the Probation Division or any other agency responsible for child support enforcement, upon request.
U
nder the provisions of N.J.S.A. 2A:17-56.7 et seq., responses to the questions listed below are required.
Intentional misstatements may result in administrative action including, but not limited to, denial of
licensure, immediate suspension or revocation of the license.
1. D
o you have a child support obligation?
2.
I
f yes, do the arrearage amounts equal or exceed the amount of child support
payable for six months
?
3.
A
re you subject to a child-support warrant
?
I certify that the foregoing responses made by me are true and I am aware that the making of false
statements may subject me to contempt of court.
____
__________________________________________ __________________
Signature Date
P.O. Box 168
Trenton, New Jersey 08666-0168
(609)
292
-6500 #5014
Yes
No
Yes
No
Yes
No
BLS-43 (R10/12)
New Jersey
Trenton, New Jersey 08666
Motor Vehicle Commission
STATE OF NEW JERSEY
(888) 486-3339 ext.5094 toll-free in NJ
(609) 292-6500 ext.50
94
mvcblscorrespondence@dot.state.nj.us
May 10,2001
TO: ALL DRIVING SCHOOLS
All applicants who wish to obtain an initial Driving School Instructor's license may do so
on a walk in
basis between the hours of 8:00 am and 11:00 am at the following Driver
Testing Centers.
EATONTOWN TRENTON
RAHWAY WAYNE
1. All items listed on the attached checklist must be mailed to Business License
Compliance Driving School Unit POB 168 Trenton, New Jersey 08666 prior to the
applicant(s) appearing for the tests.
2. Written and vision test will be administered when applicant appears at the Driver
Testing Center.
3. Scheduling of the road test will be made by the Driver Testing Center after the
vision and written testing phase has been successfully completed. The road test
may be scheduled the same day if time and staffing allows. If the road test
schedule is full, the test will be scheduled on the next available day.
4. The permanent license will not be issued until we receive the results of the
instructor test and fingerprint check.
BUSINESS LICENSING SERVICES BUREAU
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Form 170: -0170 -6500 ext. 5014 609-292-4400 (The State of New Jersey)

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Completed 13 October 2020

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