Fillable Instructions for Reinstatement (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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Instructions for Reinstatement (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
Fire Alarm, Burglar Alarm and
Locksmith Advisory Committee
124 Halsey Street, 6th Floor, P.O. Box 45042
Newark, New Jersey 07101
(973) 504-6245
Instructions for Reinstatement
In accordance with the Uniform Enforcement Act, a professional or occupational license or certicate of registration may be
reinstated, provided that the applicant otherwise qualies for licensure, registration or certication, and complies with the
provisions of N.J.S.A. 45:1-7.2 a, b, c and d.
The necessary application and materials for applying for reinstatement are enclosed.
1. Complete the enclosed Application for Reinstatement. (Please submit one application for each license category.)
2. Enclose the following:
• Payment of all past delinquent license renewal fees and payment of the current reinstatement fee;
• An Afdavit of Employment listing each job held during the lapsed licensure or certication period. This Afdavit
of Employment must include the names, addresses and telephone numbers of each employer;
• A notarized statement that clearly indicates whether you were engaged in the practice of your profession or
occupation in New Jersey during the period that your New Jersey license or certicate was suspended. You must
include a description of the type of work or projects with which you were involved if you were practicing your
profession or occupation during this period;
• Certicates of completion that show you completed the continuing education units required for any triennial
period during which you were suspended; and
• A copy of the certicate or license in good standing from any other jurisdiction if you did engage in the alarm
business or locksmith business during the triennial period your license was suspended in New Jersey.
3. N.J.A.C. 13:31A-1.4 - Fee schedule
Licensure Reinstatement Fee
Year license lasped Total fee due
2013
$340.00
2016
$220.00
The fees are calculated based on the fee for the triennial cycle that
has occured since the license has lapsed, plus a reinstatement fee of
$100.00 which is already included in the total fee due noted above.
4. Submit to the:
Division of Consumer Affairs
Fire Alarm, Burglar Alarm and Locksmith Advisory Committee
P.O. Box 45042
Newark, New Jersey 07101
Please note that a check or money order must accompany this application for the reinstatement of your license.
Upon review and approval of your reinstatement application, a license will be issued.
New Jersey Ofce of the Attorney General
Division of Consumer Affairs
Fire Alarm, Burglar Alarm and
Locksmith Advisory Committee
124 Halsey Street, 6th Floor, P.O. Box 45042
Newark, New Jersey 07101
(973) 504-6245
Application for Reinstatement
Indicate the type of license for which you seek reinstatement: (Please submit one application for each license catgory.)
Burglar Alarm License Fire Alarm License Locksmith License
License No.: D
A nonrefundable reinstatement fee of $100.00, along with all past delinquent renewal fees, in the form of
a check or money order made out to the State of New Jersey, must be submitted with this application for
reinstatement (applicants should understand that if the application filing fee is paid with a personal check, and
the check is returned by the bank due to insufficient funds, the next step in the reinstatement 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. 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 (including your address of record) 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
1. Name ________________________________________________________________________ ( _______________________)
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
3. Social Security Number
You must provide your Social Security number to the Board or Committee. Failure to do so may result in the denial of reinstatement
of your licensure or certication.
*Social Security Number: __________ -__________ - ___________
*Pursuant to N.J.S.A. 54:50-24 et seq. of the New Jersey taxation law, N.J.S.A. 2A:17-56.44e of the New Jersey Child
Support Enforcement Law, Section 1128E(b)(2)A of the Social Security Act and 45 C.F.R. 60.7,60.8 and 60.9, the Board or
Committee is required to obtain your Social Security number. Pursuant to these authorities, the Board or Committee is also
obligated to provide your Social Security number to:
a. the Director of Taxation to assist in the administration and enforcement of any tax law, including for the purpose of reviewing
compliance with State tax law and updating and correcting tax records; and
b. the Probation Division or any other agency responsible for child support enforcement, upon request.
4. Citizenship / Immigration Status
Federal law limits the issuance or renewal of professional or occupational licenses or certicates to U.S. citizens or qualied aliens.
To comply with this federal law, check the appropriate box below which indicates your citizenship/immigration status. If you are not
a U.S. citizen, attach a copy of your alien registration card (front and back) or other documentation issued by the ofce of U.S.
Citizenship and Immigration Services (USCIS).
U.S. citizen
Alien lawfully admitted for permanent residence in U.S.
Other immigration status
Questions about your immigration status and whether or not it is a qualifying status under federal law should be directed to the
USCIS at: 1-800-375-5283.
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 unless you provide the
required documents concerning the plan for repayment of your student loan.
6. Child Support (You must answer a, b, c and d.)
Please certify, under penalty of perjury, the following:
a. Do you currently have a child-support obligation? Yes No
(1) If “Yes,” are you in arrears in payment of said obligation? Yes No
(2) If “Yes,” 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 licensure.
___________________________________ ___________________________________ ________________________
Applicant’s name (please print) Applicant’s signature Date
7. Have you ever changed your name? Yes No
If “Yes,” please submit with this application a copy of the marriage certicate, divorce decreee or court order.
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 proivde 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
11. Have you ever been disciplined or denied a professional or occupational license or certicate of any kind in New Jersey,
any other state, the District of Columbia or in any other jurisdiction? Yes No
12. Have you ever had a professional or occupational 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 nes or other penalties) ever been taken against your professional or occupational 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 re/burglar alarm installation or repair,
locksmithing or other professional or occupational 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 or occupational license or certicate issued to you by a
professional or occupational 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
or occupational group related to the practice of re/burglar alarm installation or repair, locksmithing or other professional or
occupational practice in New Jersey, any other state, the District of Columbia or in any other jurisdiction?
Yes No
If the answer to any of the above questions, excluding question number 10, is “Yes,” provide a complete explanation of the
circumstances leading to the action, and any supporting documentation, on separate sheets of paper.
Employment since your license expired. (You may photocopy this page if necessary.)
Employer’s name: ________________________________________________________________________________________
Employer’s address: ______________________________________________________________________________________
Street address City State ZIP code
Immediate supervior’s name: ______________________________________________________________________________
Employer’s telephone number: _______________________________ (include area code) Hours per week: _____________
Your major responsibilities (use additional sheets of paper if necessary):
Dates employed: from ___________________________ to ___________________________
Month Day Year Month Day Year
Employer’s name: ________________________________________________________________________________________
Employer’s address: ______________________________________________________________________________________
Street address City State ZIP code
Immediate supervior’s name: ______________________________________________________________________________
Employer’s telephone number: _______________________________ (include area code) Hours per week: _____________
Your major responsibilities (use additional sheets of paper if necessary):
Dates employed: from ___________________________ to ___________________________
Month Day Year Month Day Year
Employer’s name: ________________________________________________________________________________________
Employer’s address: ______________________________________________________________________________________
Street address City State ZIP code
Immediate supervior’s name: ______________________________________________________________________________
Employer’s telephone number: _______________________________ (include area code) Hours per week: _____________
Your major responsibilities (use additional sheets of paper if necessary):
Dates employed: from ___________________________ to ___________________________
Month Day Year Month Day Year
___________________________________ ___________________________________ ________________________
Applicant’s name (please print) Applicant’s signature Date
Continuing Education
Individuals applying to reinstate a re alarm, burglar alarm or locksmithing license are required to provide proof that they have
completed 24 credit hours of continuing education for the current triennial registration period within three years prior to the
date of application for reinstatement, consistent with the requirements set forth in N.J.A.C. 13:31A-1.12. The 24 credit hours is
required for each license held - Fire Alarm, Burglar Alarm and/or Locksmith. In the aggregate, a holder of a single license must
earn 24 total credit hours, a holder of two licenses must earn 38 total credit hours, and a holder of three licenses must earn
52 total credit hours during the triennial cycle. Please list all of the courses that you have successfully completed since your
license expired or was suspended.
Please attach copies of the certicates of completion for each course listed.
Date of course Name of sponsor Title of program
No. of
credits
CertifiCation for reinstatement appliCation
I, _______________________________________________________ , in making this application to the Board or Committee for
reinstatement/reactivation of 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 reinstatement/reactivation 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 reinstatement/reactivation. 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.
___________________________________ ______________________________________________
Date Signature of applicant
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Instructions for Reinstatement (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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