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New Jersey Ofce of the Attorney General
Division of Consumer Affairs
State Board of Respiratory Care
124 Halsey Street, 6th Floor, P.O. Box 45031
Newark, New Jersey 07101
(973) 504-6485
IMPORTANT NOTICE
Effective July 21, 2017
Enacted by the Senate and General Assembly of the State of New Jersey:
N..J.S.A. C.45:14E-15- Issuance of License.
15. The Board shall issue a license to perform respiratory care to an applicant, who, at the time of
the effective date of this act, has passed the Registered Respiratory Therapist examination offered
by the National Board for Respiratory Care, or by a successor organization.
New Jersey Ofce of the Attorney General
Division of Consumer Affairs
State Board of Respiratory Care
124 Halsey Street, 6th Floor, P.O. Box 45031
Newark, New Jersey 07101
(973) 504-6485
Dear Applicant:
Pursuant to your request, enclosed is the material necessary to apply for a New Jersey license to practice respiratory care. Please
review this material carefully. Some portions of this package apply to credentialed practitioners who qualify for permanent licensure. Other
portions apply to graduates of an accredited Respiratory Care Program who have not yet passed the N.B.R.C. entry-level examination,
but who qualify for a temporary license in New Jersey.
Vital Step in Application Process:
You must remember to call the Board’s staff at (973) 504-6485 to be certain that the Board has in fact received both your
application for licensure and the application fee BEFORE you request either your transcripts from any school you have attended
or any documentation from any other parties. (For example, all medical verication forms.) In addition, please note that 1) under
the medical conditions section of the application (question number 7), there are instances when the answer “not applicable” may
apply, and 2) it is a very good idea to make sure that you have read the entire application before lling it out.
All applicants for licensure must show evidence of:
1. Having earned a U.S. high school diploma or its equivalent;
2. Having successfully completed:
a. A Respiratory Care Program accredited by the Joint Review Committee for Respiratory Care Education (J.R.C.R.C.E.) of the
Council on Allied Health Education and Accreditation, or its successor; and
b. The entry-level examination of the National Board of Respiratory Care (N.B.R.C.).
It is the responsibility of individual candidates for licensure to make arrangements to sit for the N.B.R.C. examination or, if applicable,
to verify existing credentials. Candidates for temporary licensure are expected to sit for the next available exam. In order to expedite the
processing of your application and to avoid further expense, temporary license candidates should complete the Examination Score Release
form and return it to the N.B.R.C. Inquiries about the exam or the verication of credentials should be directed to:
The National Board for Respiratory Care, Inc.
18000 W. 105th Street
Olathe, KS 66061-7543
Tel. (913) 895-4900
www.nbrc.org
Specic instructions will follow. Please be sure to follow each instruction with extreme care. Different data may be required to answer
each question, and an incomplete application cannot be processed. You should direct any questions you may have to the Board’s ofce
at the address indicated above.
Very truly yours,
State Board of Respiratory Care
Dorcas K. O’Neal
Executive Director
New Jersey Ofce of the Attorney General
Division of Consumer Affairs
State Board of Respiratory Care
124 Halsey Street, 6th Floor, P.O. Box 45031
Newark, New Jersey 07101
(973) 504-6485
Respiratory Care Checklist
Requirements for Permanent Licensure in New Jersey
Below is a numbered list of the documents required for licensure. Failure to submit these documents will delay processing. Please read
this list carefully. Put a check in each of the boxes on this list as you complete each applicable requirement.
1. Notarized Application
The notarized application is to be submitted with a 2” by 2” passport-size photograph and a nonrefundable fee of $125.00 in the
form of a certied check, personal check or money order, payable to the New Jersey State Board of Respiratory Care. Please
note that a post ofce box may only be used as your address of record if you also provide another address that includes
a street, city, state and ZIP code. The application must be completed in its entirety and no line should be left blank.
2. Biennial License Fee
All permanent respiratory care licenses must be renewed biennially. Applicants are required to remit payment of
$160.00 in the form of a certied check, personal check, or money order, payable to the New Jersey Board of Respiratory
Care with the application fee. This fee may be prorated for the second year of the biennial licensure period. On
March 31st of every odd year, the biennial licensure fee is $80.00 until the biennial expiration date March 31st of the following
even year.
3. Certication of Valid Licensure
If applicable, this form is to be forwarded to each state or jurisdiction in which you are licensed. This form may be copied if you are
licensed in more than one state or jurisdiction. Each state or jurisdiction may have a fee for this service. It is the applicant’s
responsibility to contact each board to nd out how much the fee is and where to send it.
4. Certicate of Good Standing
Non-Respiratory Care Practitioner
License/Registration/Permit/Certicate
All applicants are required to
forward one form to each state where you hold or have held a state-
issued license,
registration, permit or certicate as a health care provider other than a respiratory care practioner. Extra c
opies may be
photocopied
if needed.
5. New Jersey Employer’s Statement Form
A. If you have not worked as a respiratory therapist in the State of New Jersey since the inception of the Board (May 1992),
please complete Section I and sign the form as instructed.
B. If you are currently employed or have in the past worked in the State of New Jersey, please have your employer complete
Section II, answering all of the questions that are applicable. This form should be photocopied if you have or have had more
than one employer. You may also download the form at www.NJConsumerAffairs.gov.
6. New Jersey Verication of Medical Employment
If applicable, this form is to be completed by your previous employer(s). Please have it completed in its entirety. This form
should be completed for employment in the past 10 years. This form should be photocopied if you have had more than one employer.
A letterhead or business card must be attached to the form. You may also download the form at www.NJConsumerAffairs.gov.
7. Out-of-State Verication of Medical Employment
If applicable, this form is to be completed by your previous employer(s). Please have it completed in its entirety. This form
should be completed for employment in the past 10 years. This form should be photocopied if you have had more than one employer.
A letterhead or business card must be attached to the form. You may also download the form at www.NJConsumerAffairs.gov.
8. Verication of Non-Medical Employment
If applicable, this form is to be completed by your previous employer(s). Please have it completed in its entirety. This form should
be completed for employment in the past 10 years. This form should be photocopied if you have had more than one employer. A
letterhead or business card must be attached to the form. You may also download the form at www.NJConsumerAffairs.gov.
9. N.B.R.C. Examination Score Release Form
This form is to be completed and sent to the N.B.R.C. (highlighted address on form) with the appropriate fee for verication of
your credentials which must be sent directly to the Board.
10. Copy of High School Transcript with School Seal/Notarized High School Diploma
All applicants are required to request that their ofcial high school transcript or its equivalent be forwarded from the high school
to this ofce. Foreign graduates are required to have their transcripts evaluated by a Board-approved evaluator (the list of
evaluators is attached). If your transcripts are not mailed directly from your high school, they must be notarized before sending
them to the State Board of Respiratory Care.
11. Notarized Copy of Name Change
If applicable, an applicant whose name has changed must forward a notarized copy of the documented proof of a name change to the
State Board of Respiratory Care.
12. Notarized Copy of Citizenship/Alien Registration Card
If applicable, this notarized certicate must be provided to prove that you are a legal resident of the United States.
13. Notarized Copy of the Certicate of Completion (Certicate/Degree)
All applicants are required to submit a notarized copy of the Certicate of Completion (certicate or degree from an accredited
institution or college) to the Board, proving successful completion of a Respiratory Care program accredited by the Committee
on Accreditation for Respiratory Care.
14. Certicate and Authorization Form for a Criminal History Background Check
All applicants are required to submit a Certication and Authorization Form for a Criminal History Background Check. Please
complete the form in its entirety, sign the form and return it to the mailing address on the previous page. If you live out-of-state,
fingerprint cards (if applicable) with a complete set of instructions will be sent to you upon receipt of the
Certication and Authorization Form for a Criminal History Background Check.
Revised October 2013
New Jersey Ofce of the Attorney General
Division of Consumer Affairs
State Board of Respiratory Care
124 Halsey Street, 6th Floor, P.O. Box 45031
Newark, New Jersey 07101
(973) 504-6485
Respiratory Care Checklist
Requirements for Temporary Licensure in New Jersey
Below is a numbered list of documents required for licensure. Failure to submit these documents will delay processing. Please read
this list carefully. Put a check in each of the boxes on this list as you complete each applicable requirement.
1. Notarized Application
The notarized application is to be submitted with a 2” by 2” passport-size photograph and a nonrefundable fee of $125.00 in the
form of a certied check, personal check or money order, payable to the New Jersey State Board of Respiratory Care. Please
note that a post ofce box may only be used as your address of record if you also provide another address that includes
a street, city, state and ZIP code. The application must be completed in its entirety and no line should be left blank.
2. Temporary License Fee
Applicants are required to remit with the notarized application a payment of $40.00 in the form of a certified
check, personal check or money order, payable to the New Jersey Board of Respiratory Care.
3. New Jersey Employer’s Statement Form
A. If you have not worked as a respiratory therapist in the State of New Jersey since the inception of the Board (May 1992),
please complete Section I and sign the form as instructed.
B. If you are currently employed/or have worked in the State of New Jersey, please have your employer complete Section II,
answering all of the questions that are applicable. This form should be photocopied if you have or have had more than one
employer. You may also download the form at www.NJConsumerAffairs.gov.
4. New Jersey Verication of Medical Employment
If applicable, this form is to be completed by your previous employer(s). Please have it completed in its entirety. This form
should be completed for employment in the past 10 years. This form should be photocopied if you have had more than one employer.
Please have it returned directly to this ofce at the above address by your employer(s). A letterhead or business card must be attached
to the form. You may also download the form at www.NJConsumerAffairs.gov.
5. Out-of-State Verication of Medical Employment
If applicable, this form is to be completed by your previous employer(s). Please have it completed in its entirety. This form
should be completed for employment in the past 10 years. This form should be photocopied if you have had more than one employer.
Please have it returned directly to this ofce at the above address by your employer(s). A letterhead or business card must be attached
to the form. You may also download the form at www.NJConsumerAffairs.gov.
6. Verication of Non-Medical Employment
If applicable, this form is to be completed by your previous employer(s). Please have it completed in its entirety. This form should
be completed for employment in the past 10 years. This form should be photocopied if you have had more than one employer.
Please have it returned directly to this ofce at the above address by your employer(s). A letterhead or business card must be attached
to the form. You may also download the form at www.NJConsumerAffairs.gov.
7. Certication of Valid Licensure
If applicable, this form is to be forwarded to each state or jurisdiction in which you are licensed. This form may be copied if you are
licensed in more than one state or jurisdiction. Each state or jurisdiction may have a fee for this service. It is the applicant’s
responsibility to contact each board to nd out how much the fee is and where to send it.
8. Certicate of Good Standing
Non-Respiratory Care Practitioner
License/Registration/Permit/Certicate
All applicants are required to
forward one form to each state where you hold or have held a state-
issued license,
registration, permit or certicate as a health care provider other than a respiratory care practioner. Extra c
opies may be
photocopied
if needed.
9. Copy of High School Transcript with School Seal/Notarized High School Diploma
All applicants are required to request that their ofcial high school transcript or its equivalent be forwarded from the high school
to this ofce. Foreign graduates are required to have their transcripts evaluated by a Board-approved evaluator (the list of
evaluators is attached). If your transcripts are not mailed directly from your high school, they must be notarized before sending
them to the State Board of Respiratory Care.
10. Notarized Copy of Citizenship/Alien Registration Card/Marriage Certicate
A. If applicable, applicants who have changed their names must forward a notarized copy of the documented proof of
their name change to the State Board of Respiratory Care.
B. If applicable, this notarized certicate must be provided to prove that you are a legal resident of the United States.
11. Notarized Copy of Certicate of Completion (Certicate/Degree)
All applicants are required to submit a notarized copy of the Certicate of Completion (certicate or degree from an accredited
institution or college) to the Board, proving successful completion of a Respiratory Care program accredited by the Committee
on Accreditation for Respiratory Care.
12. Certicate and Authorization Form for a Criminal History Background Check
All applicants are required to submit a Certication and Authorization Form for a Criminal History Background Check. Please
complete the form in its entirety, sign the form and return it to the above mailing address. If you live out-of-state, ngerprint cards
(if applicable) with a complete set of instructions will be sent to you upon receipt of the Certication and Authorization Form for a
Criminal History Background Check.
Revised October 2013
New Jersey Ofce of the Attorney General
Division of Consumer Affairs
State Board of Respiratory Care
124 Halsey Street, 6th Floor, P.O. Box 45031
Newark, New Jersey 07101
(973) 504-6485
Application for Licensure as a Respiratory Care Practitioner
Date: _____________________________
A nonrefundable application ling fee of $125 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 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.
Are you applying for a permanent
or a temporary license as a
respiratory therapist?
Please put a check in the
appropriate box.
Permanent
Temporary
3. Social Security Number
You must provide your Social Security number to the Board or Committee. Failure to do so will 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;
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. 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 or certicate unless you provide the
required documents concerning the plan for repayment of your student loan.
6. 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 will 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 or certication.
___________________________________ ___________________________________ ________________________
Applicant’s name (please print) Applicant’s signature Date
7. Medical Conditions Questions
Questions a through f pertain to medical conditions and use of chemical substances. Please read the denitions carefully. Your
responses will be treated condentially and retained separately. Please be aware that you have the right to elect not to answer those
portions of the following questions which inquire as to the illegal use of controlled dangerous substances or activity if you have
reasonable cause to believe that answering may expose you to the possibility of criminal prosecution. In that event, you may assert
the Fifth Amendment privilege against self-incrimination. Any claim of Fifth Amendment privilege must be made in good faith. If
you choose to assert the Fifth Amendment, you must do so in writing. You must fully respond to all other questions on the applica
tion.
Your application for licensure or certication will be processed if you claim the Fifth Amendment privilege against self-incrimination.
You should be aware, however, that you may later be directed by the Attorney General to answer a question that you have refused
to answer on the basis of the Fifth Amendment, provided that the Attorney General rst grants you immunity afforded by statutory
law. (N.J.S.A. 45:1-20.)
For the purposes of these questions, the following phrases or words have the following meanings:
“Ability to practice respiratory care” is to be construed to include all of the following:
a. The cognitive capacity to exercise reasonable respiratory care judgments and to learn and keep abreast of professional
developments; and
b. The ability to communicate those judgments and related information to patients and other interested parties, with or without the
use of aids or devices, such as voice ampliers; and
c. The physical capability to perform the duties of a respiratory care practitioner, with or without the use of aids or devices, such
as corrective lenses or hearing aids.
“Medical Condition” includes physiological, mental or psychological conditions or disorders, such as, but not limited to orthope
dic,
visual, speech and hearing impairments, cerebral palsy, epilepsy, muscular dystrophy, multiple sclerosis, cancer, heart disease,
dia
betes, mental retardation, emotional or mental illness, specic learning disabilities, H.I.V. disease, tuberculosis, drug addiction
and alcoholism.
“Chemical substance” is to be construed to include alcohol, drugs or medications, including those taken pursuant to a valid
pre
scription for legitimate medical purposes and in accordance with the prescriber’s direction, as well as those used illegally.
“Currently” does not mean on the day of, or even in the weeks or months preceding the completion of this application. Rather,
it means recently enough so that the use of drugs may have an ongoing impact on one’s functioning as a licensee, or within the
previous two years.
“Illegal use of controlled dangerous substance” means the use of a controlled dangerous substance obtained illegally (e.g.
heroin or cocaine) as well as the use of controlled dangerous substances which are not obtained pursuant to a valid prescription or
not taken in accordance with the directions of a licensed health care practitioner.
a.
Do you have a medical condition which in any way impairs or limits your ability to practice your profession with reasonable
skill and safety? Yes No
b. Are the limitations or impairments caused by your medical condition reduced or ameliorated because you receive ongoing
treatment (with or without medications) or participate in a monitoring program**?
Yes No Not applicable
c. Are the limitations or impairments caused by your medical condition reduced or ameliorated because of the eld of practice,
the setting or manner in which you have chosen to practice? Yes No Not applicable
d. Does your use of chemical substance(s) in any way impair or limit your ability to practice your profession with reasonable skill
and safety? Yes No Not applicable
e. Have you ever been diagnosed as having or have you ever been treated for pedophilia, exhibitionism or voyeurism?
Yes No
f. Are you currently engaged in the illegal use of controlled dangerous substances? (Recall that “currently” is dened as “within
the last two years.”) Yes No
If you answered “Yes” to question f, are you currently participating in a supervised rehabilitation program or professional
assistance program which monitors you in order to assure that you are not engaging in the illegal use of controlled dangerous
substances? Yes No
** If you receive such ongoing treatment or participate in such a monitoring program, the Board will make an individualized
assessment of the nature, the severity and the duration of the risks associated with an ongoing medical condition so as to determine
whether an unrestricted license or certicate should be issued, whether conditions should be imposed or whether you are not
eligible for licensure or certication.
____________________________________________________ ___________________________________
Applicant’s signature Date
8. 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
9. 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 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.)
10.
Do you currently hold, or have you ever held, 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
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
_____________________ _______________________ ____________________________ ____________________
Type of license or certicate Number State or jurisdiction that issued the license or certicate Date issued/expired
11. Have you ever been cited for disciplinary reasons 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
12. 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
13. Has any action (including the assessment of fines or other penalties) ever been taken against your professional practice
by any agency or certication board in New Jersey, any other state, the District of Columbia or in any other jurisdiction?
Yes No
14. Have you ever been named as a defendant in any litigation related to the practice of respiratory care or other professional practice
in New Jersey, any other state, the District of Columbia or in any other jurisdiction? Yes No
15. 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
16. 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
17. 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 respiratory care 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 11 through 17, is “Yes,” provide a complete explanation of the circumstances
leading to the action, and any supporting documentation, on separate sheets of paper.
Education
1. What is the name and address of the high school you attended? _____________________________________________________
Name of high school
_______________________________________________________________________________________________________
Street address City State ZIP code
2. What years did you attend high school? _____________________
3. Did you graduate from high school? Yes No
If “Yes,” what was 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. What is the name and address of the colleges or universities you have attended?
Name of college or university
Street address City State ZIP code
Name of college or university
Street address City State ZIP code
Name of college or university
Street address City State ZIP code
Name of college or university
Street address City State ZIP code
5. List all of the degrees that you have received from recognized colleges or universities. Please have each college or university forward
to the Board the ofcial transcript for each degree that you have earned, after you have called the Board’s staff at (973) 504-6485 to
make sure the Board has already received this application and the application ling fee.
Educational institution Inclusive years Degree, Major Date granted
Diploma or
Certicate
_______________________ ____________ ____________ ___________ _______________________
_______________________ ____________ ____________ ___________ _______________________
_______________________ ____________ ____________ ___________ _______________________
_______________________ ____________ ____________ ___________ _______________________
Employment History
1. Please document your work experience below. Begin with your current or most recent experience and then provide the relevant
information as you work back in time, chronologically. (You may photocopy this page if you’ve had more than 3 employers.)
(a) Employer: ___________________________________________________________________________________________
Address: ____________________________________________________________________________________________
Street address City State ZIP code
Telephone number: __________________________________
(include area code)
Title of your position: _____________________________________________________ Hours per week: __________________
Your major responsibilities (use additional sheets of paper if necessary): _____________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
From ____________________________________________ to ________________________________________________
Month Year Month Year
Immediate supervisor’s name and title: ____________________________________________________________________
(b) Employer: ___________________________________________________________________________________________
Address: ____________________________________________________________________________________________
Street address City State ZIP code
Telephone number: __________________________________
(include area code)
Title of your position: __________________________________________________ Hours per week: __________________
Your major responsibilities (use additional sheets of paper if necessary): __________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
From ____________________________________________ to ________________________________________________
Month Year Month Year
Immediate supervisor’s name and title: ____________________________________________________________________
(c) Employer: ___________________________________________________________________________________________
Address: ____________________________________________________________________________________________
Street address City State ZIP code
Telephone number: __________________________________
(include area code)
Title of your position: __________________________________________________ Hours per week: __________________
Your major responsibilities (use additional sheets of paper if necessary): __________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
From ____________________________________________ to ________________________________________________
Month Year Month Year
Immediate supervisor’s name and title: ____________________________________________________________________
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 State Board of Respiratory Care
for licensure or certication under the provisions of Title 45 of the General Statutes of New Jersey and the Rules of the State
Board of Respiratory Care, 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 afrm) that I have read N.J.S.A. 45:14E-1 et seq., together with the Rules and Regulations of the
State Board of Respiratory Care, N.J.A.C. 13:44F-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.
_____________________________________________
Applicant’s signature
Sworn and subscribed to before me this _____________
day of _________________________ , ____________
Month Year
Afx Seal Here
_____________________________________________
Name of Notary Public (please print)
_____________________________________________
Signature of Notary Public
} ss.
For ofce use
New Jersey Ofce of the Attorney General
Division of Consumer Affairs
State Board of Respiratory Care
124 Halsey Street, 6th Floor, P.O. Box 45031
Newark, New Jersey 07101
(973) 504-6485
New Jersey Employer’s Statement Form
Section I: If applicable, this section is to be completed by the employee/applicant. Please print clearly.
I. I ,________________________________________________,
certify that I have not worked as a respiratory care practitioner
(Applicant/Employee Name)
in New Jersey since May 1992.
Section II:
If the applicant has worked in New Jersey as a respiratory therapist since May 1992, this section is to be completed by the
employer.
II. I, ________________________________________, certify that ______________________________________
has worked under
(Employer Name) (Employee Name)
my supervision as a/an _______________________________________________ for ___________________
in the State of New
( Title of Position) (Hours Per Week)
Jersey. The period worked was from ___________________________________ to________________________________ .
(Start Date) (End Date/Current)
Check all of the appropriate boxes.
Specic Duties Included:
Administration of Medical Gases
Application of Oxygen-Administering Apparatus
Administration of Environment Control Systems
Administration of Humidication and Aerosols
Administration of Drugs and Medication
Application/Management of Apparatus for Cardio-Respiratory Support & Control
Initiated Procedures Related To:
Postural Drainage
Chest Percussion and Vibration
Breathing Exercise(s)
Respiratory Rehabilitation
Assisted With:
Cardio-Pulmonary Resuscitation
Maintenance of Natural and Mechanical Airways
Insertion and Maintenance of Articial Airways
Measurement of Cardio-Respiratory Volumes, Pressure and Flow
Drawing and Analyzing of Samples of Arterial, Capillary and Venous Blood
I certify that the information contained herein is true, correct and complete to the best of my knowledge. I realize that if any of the following
is essentially false, I am subject to punishment.
_____________________________________________________ ___________________________________________________
(Name of Facility) (Address of Facility)
_____________________________________________________
(Telephone Number of Facility - Include Area Code)
_____________________________________________________ ___________________________________________________
(Signature of Employee) (Date) (Signature of Employer) (Date)
RC-4
Revised 2009
click to sign
signature
click to edit
New Jersey Ofce of the Attorney General
Division of Consumer Affairs
State Board of Respiratory Care
124 Halsey Street, 6th Floor, P.O. Box 45031
Newark, New Jersey 07101
(973) 504-6485
New Jersey Verication of Medical Employment
(This form is to be completed by the applicant’s most recent employer(s).)
Employer: Please attach the facility’s letterhead and/or business card to this form and send it directly to the Board.
Applicant’s Name: _______________________________________________________________________________________
Employer’s Name: ____________________________________________________________________________________________
Employer’s Address:___________________________________________________________________________________________
Employer’s Telephone Number:__________________________________________________________________________________
1. What position did the above individual hold when employed by you? _________________________________________________
________________________________________________________________________________________________________
2. What were his/her dates of employment? From_______________ To _________________
3. Did he or she leave your employment in good standing? Yes No
4. Was this individual on probation, suspended, sanctioned or disciplined while employed by you? Yes No
5. Was this individual granted a leave of absence while employed by you? Yes No
6. Were any restrictions placed on his or her activities which were not placed on all other employees holding similar positions?
Yes No
7. Were any incident reports led involving the professional conduct or behavior of this individual? Yes No
8. Was he or she ever subject to nonroutine monitoring while in your employ? Yes No
9. Was this individual subject to nonroutine quality assessment review? Yes No
10. Did quality assessment review of this individual ever result in a negative nding? Yes No
11. Were any malpractice actions led naming this health practitioner as a defendant that involved his or her period of employment at your
facility? Yes No
12. Would you consider employing this health practitioner again? Yes No
13. Would you recommend this health practitioner for privileges at your facility? Yes No
If you answered “No” to questions number 3, 12 or 13, or “Yes” to questions number 4 through 11, please explain._____________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Please see other side.
click to sign
signature
click to edit
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Please supply any additional comments or information that the Board should consider prior to determining this applicant’s eligibility
for licensure. ______________________________________________________________________________________________
_________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Print the name of the employer supplying information:_____________________________________________________________________
Signature of the employer supplying information:______________________________________________________________________
Date form was completed :_________________________________________________________
NOTE: COPIES OR FAXES OF THE REQUIRED LETTERHEAD OR BUSINESS CARD WILL NOT BE ACCEPTED AS
ORIGINAL DOCUMENTS.
PLEASE RETURN DIRECTLY TO:
State Board of Respiratory Care
124 Halsey Street 6th Floor
P.O. Box 45031
Newark, New Jersey 07101
RC - 5
Revised 2009
New Jersey Ofce of the Attorney General
Division of Consumer Affairs
State Board of Respiratory Care
124 Halsey Street, 6th Floor, P.O. Box 45031
Newark, New Jersey 07101
(973) 504-6485
Out-of-State Verication of Medical Employment
(This form is to be completed by the applicant’s most recent employer(s).)
Employer: Please attach the facility’s letterhead and/or business card to this form and send it directly to the Board.
Applicant’s Name: ____________________________________________________________________________________________
Employer’s Name: ____________________________________________________________________________________________
Employer’s Address:___________________________________________________________________________________________
Employer’s Telephone Number:__________________________________________________________________________________
1. What position did the above individual hold when employed by you? _________________________________________________
________________________________________________________________________________________________________
2. What were his/her dates of employment? From_______________ To _________________
3. Did he or she leave your employment in good standing? Yes No
4. Was this individual on probation, suspended, sanctioned or disciplined while employed by you? Yes No
5. Was this individual granted a leave of absence while employed by you? Yes No
6. Were any restrictions placed on his or her activities which were not placed on all other employees holding similar positions?
Yes No
7. Were any incident reports led involving the professional conduct or behavior of this individual? Yes No
8. Was he or she ever subject to nonroutine monitoring while in your employ? Yes No
9. Was this individual subject to nonroutine quality assessment review? Yes No
10. Did quality assessment review of this individual ever result in a negative nding? Yes No
11. Were any malpractice actions led naming this health practitioner as a defendant that involved his or her period of employment at your
facility? Yes No
12. Would you consider employing this health practitioner again? Yes No
13. Would you recommend this health practitioner for privileges at your facility? Yes No
If you answered “No” to questions number 3, 12 or 13, or “Yes” to questions number 4 through 11, please explain.____________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Please see other side.
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Please supply any additional comments or information that the Board should consider prior to determining this applicant’s eligibility
for licensure. ______________________________________________________________________________________________
_________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Print the name of the employer supplying information:_____________________________________________________________________
Signature of the employer supplying information:______________________________________________________________________
Date form was completed :_________________________________________________________
NOTE: COPIES OR FAXES OF THE REQUIRED LETTERHEAD OR BUSINESS CARD WILL NOT BE ACCEPTED AS
ORIGINAL DOCUMENTS.
PLEASE RETURN DIRECTLY TO:
State Board of Respiratory Care
124 Halsey Street 6th Floor
P.O. Box 45031
Newark, New Jersey 07101
RC - 6
Revised 2009
New Jersey Ofce of the Attorney General
Division of Consumer Affairs
State Board of Respiratory Care
124 Halsey Street, 6th Floor, P.O. Box 45031
Newark, New Jersey 07101
(973) 504-6485
Verication of Non-Medical Employment
(This form is to be completed by the applicant’s most recent employer(s).)
Employer: Please attach the facility’s letterhead and/or business card to this form and send it directly to the Board.
Applicant’s Name: ____________________________________________________________________________________________
Employer’s Name: ____________________________________________________________________________________________
Employer’s Address:___________________________________________________________________________________________
Employer’s Telephone Number:__________________________________________________________________________________
1. What position did the above individual hold when employed by you? _________________________________________________
________________________________________________________________________________________________________
2. What were his/her dates of employment? From_______________ To _________________
3. Did he or she leave your employment in good standing? Yes No
4. Was this individual on probation, suspended, sanctioned or disciplined while employed by you? Yes No
5. Was this individual granted a leave of absence while employed by you? Yes No
6. Were any restrictions placed on his or her activities which were not placed on all other employees holding similar positions?
Yes No
7. Were any incident reports led involving the professional conduct or behavior of this individual? Yes No
8. Was he or she ever subject to nonroutine monitoring while in your employ? Yes No
9. Was this individual subject to nonroutine quality assessment review? Yes No
10. Did quality assessment review of this individual ever result in a negative nding? Yes No
11. Were any malpractice actions led naming this health practitioner as a defendant that involved his or her period of employment at your
facility? Yes No
12. Would you consider employing this health practitioner again? Yes No
13. Would you recommend this health practitioner for privileges at your facility? Yes No
If you answered “No” to questions number 3, 12 or 13, or “Yes” to questions number 4 through 11, please explain._____________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Please see other side.
click to sign
signature
click to edit
click to sign
signature
click to edit
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Please supply any additional comments or information that the Board should consider prior to determining this applicant’s eligibility
for licensure. ______________________________________________________________________________________________
_________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Print the name of the employer supplying information:_____________________________________________________________________
Signature of the employer supplying information:______________________________________________________________________
Date form was completed :_________________________________________________________
NOTE: COPIES OR FAXES OF THE REQUIRED LETTERHEAD OR BUSINESS CARD WILL NOT BE ACCEPTED AS
ORIGINAL DOCUMENTS.
PLEASE RETURN DIRECTLY TO:
State Board of Respiratory Care
124 Halsey Street 6th Floor
P.O. Box 45031
Newark, New Jersey 07101
RC - 7
Revised 2009
click to sign
signature
click to edit
click to sign
signature
click to edit
New Jersey Ofce of the Attorney General
Division of Consumer Affairs
State Board of Respiratory Care
124 Halsey Street, 6th Floor, P.O. Box 45031
Newark, New Jersey 07101
(973) 504-6485
Certicate of Good Standing
Non-Respiratory Care Practitioner
License/Registration/Permit/Certicate
Please complete the top portion only and forward one form to each state where you hold or have held a state-
issued license, registration, permit or certicate as a health care provider other than a respiratory care practioner.
Extra c
opies may be
photocopied if needed.
This section is to be completed by the applicant:
I,_________________________________________,
am applying for a New Jersey Respiratory Care Practitioner
License.
The New Jersey State Board of Respiratory Care requests that I submit evidence that my License/
Registration/
Permit/Certicate in the State of __________________________________________________
is in good
standing.
I was granted License/Registration/Permit/Certicate Number________________________on _____________ .
Date
You are hereby authorized to release any information in your les, favorable or otherwise, directly to the State
Board of Respiratory Care, 124 Halsey Street, P.O. Box 45031, Newark, New Jersey 07101.
Your early attention is appreciated.
__________________________________________ ______________________________
Applicant’s signature Date
This section is to be completed by an Ofcial of the Issuing Authority:
Please complete and return this form to: Dept. of Law & Public Safety, Division of Consumer Affairs, State Board
of Respiratory Care
, P.O. Box 45031, Newark, New Jersey 07101.
Name:____________________________________________________________________________________
License/Registration/Permit/Certicate number:_____________________________
Date issued: _________________ Expiration date: _________________
Is the License/Registration/Permit/Certicate current? Yes  No
If “No,” please explain: ______________________________________________________________________
__________________________________________________________________________________________
Is the License/Registration/Permit/Certicate in good standing? Yes  No
If “No,” please explain:_______________________________________________________________________
__________________________________________________________________________________________
Additional information or other remarks:_________________________________________________________
_______________________ _________________________________ ____________________________
Date Print name Signature
_____________________________________ _______________________________________________
State Board Title
(Seal of the attesting Issuing Authority must be impressed over the signature.)
New Jersey Ofce of the Attorney General
Division of Consumer Affairs
State Board of Respiratory Care
124 Halsey Street, 6th Floor, P.O. Box 45031
Newark, New Jersey 07101
(973) 504-6485
Request for Verication of Credentials
To Applicant: Complete Section 1 below and submit it, along with the required $5.00 fee for active members and $20.00 fee for inactive
members, to:
National Board for Respiratory Care
18000 W. 105th Street
Olathe, KS 66061-7543
(913) 895-4900
www.nbrc.org
Section 1:
I am applying for State licensure in __________________________________, and I am requesting the N.B.R.C. to verify my
credential(s) directly to the________________________________________________.
I am requesting the N.B.R.C. to verify my credential(s) directly to:
State Board of Respiratory Care
124 Halsey St., P.O. Box 45031
Newark, New Jersey 07101
I hold the following N.B.R.C. credentials: R.R.T. C.P.F.T. C.R.T. - N.P.S.
C.R.T. R.P.F.T. R.R.T. - N.P.S.
Print the name under which you were credentialed:
_________________________________________________________________________________________________________
Last First Middle initial Maiden Name
Complete the Information Below:
______________________________
Social Security Number
_________________________________________________________________________________________________________
Last First Middle initial Former Name
_________________________________________________________________________________________________________
Street Addrees/Apt No. City State ZIP code
__________________________________ ____________________________________
Telephone number (include area code) Cell Phone number (include area code)
______________________________________________________ ____________________________________
Signature Date
RC - 8
Revised 2009
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signature
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New Jersey Ofce of the Attorney General
Division of Consumer Affairs
State Board of Respiratory Care
124 Halsey Street, 6th Floor, P.O. Box 45031
Newark, New Jersey 07101
(973) 504-6485
Certication of Valid Licensure
Please send this form to every board in the state(s) or jurisdiction(s) (except New Jersey)
where you are or have been licensed as a Respiratory Care Practitioner.
Note to applicant: This form should be forwarded directly to the State Board of Respiratory Care
by the out-of-state board(s). Failure to do so may delay the processing of your application.
Please complete the top portion only and forward one form to the board in every state or jurisdiction where you hold or have held a
license to practice respiratory care. Extra copies may be photocopied if needed. There may be a charge for this service. Be sure to ask
the board(s) where you are licensed about fees for this service.
I,______________________________________________, Social Security number ______-____-______, am applying for a New Jersey
Respiratory Care Practitioner’s license based on endorsement.
I was granted license number ___________________________ in _____________________ by the State of ______________________.
(License Number) (Month / Year)
The New Jersey State Board of Respiratory Care has requested that I submit evidence that my license in the State of ____________________
is in good standing.
(State where you are licensed)
You are hereby authorized to release any information in my le, favorable or otherwise directly to the New Jersey State Board of Respiratory
Care, P.O. Box 45031, Newark, NJ 07101. Your early attention is appreciated.
Signature:______________________________________________________________
____________________________________________________________________________________________________________
This section is to be completed by an ofcial of the board in the state where you are or have been licensed.
Please complete and return to: State Board of Respiratory Care, P.O. Box 45031, Newark, NJ 07101
Name of applicant:_____________________________________________________________________________________________
License number:_____________________________________ Date issued:____________________________
License issued through (check one): N.B.R.C. Examination/Credential State Examination Reciprocity
Endorsement Other:_______________________________
Is the license current?
Yes No If “No,” date of expiration:__________________________________
Is the license in good standing? Yes No
If “No,” please explain: ______________________________________________________________________________________________
____________________________________________________________________________________________________________
Was the license ever suspended, revoked, or was other disciplinary action taken?
Yes No
If “Yes,” please explain (attach any relevant documents):
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Derogatory Information: ________________________________________________________________________________________
____________________________________________________________________________________________________________
Remarks:_____________________________________________________________________________________________________
____________________________________________________________________________________________________________
Signature:________________________________________________________ Date:_____________________________________
State Board: ______________________________________________________ Title: ______________________________________
(The seal of the licensing board must be impressed over the board ofcial’s signature.)
Revised August 2007
New Jersey Ofce of the Attorney General
Division of Consumer Affairs
State Board of Respiratory Care
124 Halsey Street, 6th Floor, P.O. Box 45031
Newark, New Jersey 07101
(973) 504-6485
List of Recognized Credential Evaluation Services
World Education Services, Inc.
P.O. Box 745
Old Chelsea Station
New York, New York 10113-0745
(212) 966-6311
www.wes.org
9:00 a.m. - 5:00 p.m. - Customer Service
Monday-Friday
International Education Research Foundation, Inc.
Credentials Evaluation Service
P.O. Box 3665
Culver City, CA 90231-3665
(310) 258-9451
www.ierf.org
8 :0 am.- 4:00 p.m. - Customer Service
Monday - Friday
Info@ierf.org
International Consultants Inc., of Delaware
109 Barksdale Professional Center
Newark, DE 19711
(302) 737-8715
www.icdel.com
8:30 am.- 4:00 p.m. - Customer Service
Monday - Friday
Educational Credential Evaluators, Inc.
P.O. Box 92970
Milwaukee, Wisconsin 53202-0970
(414) 289-3400
www.ece.org
8:30 a.m. - 4:30 p.m. - Customer Service
Monday - Friday
New Jersey Ofce of the Attorney General
Division of Consumer Affairs
State Board of Respiratory Care
P.O. Box 45031
Newark, New Jersey 07101
(973) 504-6485
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
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IMPORTANT NOTICE New Jersey Ofce of the Attorney (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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Completed 15 August 2020

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