Fillable Instructions for Reinstating a License as a Master (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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Instructions for Reinstating a License as a Master (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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New Jersey Ofce of Attorney General
Division of Consumer Affairs
State Board of Examiners of Master Plumbers
124 Halsey Street, 6th Floor, P.O. Box 45008
Newark, New Jersey 07101
(973) 504-6420
Instructions for Reinstating a License as a Master Plumber
In accordance with the Uniform Enforcement Act, a professional or occupational license may be reinstated,
provided that the applicant otherwise qualifies for licensure and complies with the provisions of
N.J.S.A. 45:1-7.2a, b, c and d. The necessary application and materials for applying for reinstatement
are enclosed. Please follow the instructions carefully to avoid any further delays.
1. Complete:
- The enclosed Application for Reinstatement. Use this application only if your license is in expired
status.
2. Enclose with your completed application:
-
Certificate(s) of Completion for Continuing Education - proof that the licensee has maintained
prociency by completing the mandatory continuing education hours required for the renewal of
a license. Five (5) hours are required for the most current biennial cycle for which you are seeking
reinstatement.
- $3,000 Surety Bond - Send a Surety Bond in the amount of $3,000 for the most current biennial renewal
cycle for which you are requesting reinstatement.
3. Enclose a Personal Check or Money Order:
See the Reinstatement Fee Schedule below for the amount of payment due with this Application for
Reinstatement. Your check or money order should be made payable to the “State of New Jersey” for
the amount stated below and must accompany this application.
N.J.A.C 13:32-5.1 Fee Schedule
Licensure Reinstatement Fee
Year License Lapsed Total Fee Due
2015 $630.00
2017 $470.00
2019 $310.00
N.J.A.C. 13:32-2.6 Renewal of License
(e) A person seeking reinstatement within ve years following the suspension of a license pursuant to
N.J.A.C. 13:32-2.6(c), shall submit the following to the Board:
1) A completed reinstatement application;
2) Payment of all past delinquent renewal fees as set forth in N. J. A. C. 13:32-5.1;
3) Payment of a reinstatement fee as set forth in N.J.A.C. 13:32-5.1;
4) A certication verifying completion of the continuing education credits required pursuant to N.J.A.C.
13:32-6.1 for each biennial renewal period the license is suspended; and
5) An adavit of employment listing each job held during the period of suspension which includes the names,
addresses, and telephone numbers of each employer.
Note: If the year that your license expired is not listed above, please contact the Board for further instructions.
4. Submit all documents to: State Board of Examiners of Master Plumbers
P.O. Box 45008
Newark, NJ 07101
The fees are calculated based on the fee for each biennial
cycle that has occurred since the license has lapsed, plus a
reinstatement fee of $150.00 which is already included in the
total fee due noted above.
New Jersey Office of Attorney General
Division of Consumer Affairs
State Board of Examiners of Master Plumbers
124 Halsey Street, 6th Floor, P.O. Box 45008
Newark, New Jersey 07101
(973) 504-6420
Application for Reinstatement of a License to Practice as a Master Plumber
Date : _______________________________
Master Plumber License No.:______________________________
A nonrefundable reinstatement fee of $150.00, 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 (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 (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 No: ____ - ____ - ____
You must provide your Social Security number to the Board. Failure to do so will result in denial of licensure or registration
reinstatement.
*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
isrequiredtoobtainyourSocialSecuritynumber.Pursuanttothese authorities,theBoardisalsoobligatedtoprovide
yourSocialSecuritynumberto:
a. the Director of Taxation to assist in the administration and enforcement of any tax law, including for the
purpose of reviewing compliance with State tax law and updating and correcting tax records; 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 oce of U.S.
Citizenship and Immigration Services (USCIS).
U.S. citizen
Alien lawfully admitted for permanent residence in U.S.
Other immigration status
Questions about your immigration status and whether or not it is a qualifying status under federal law should be directed to the
USCIS at: 1-800-375-5283.
5. Child Support
Please certify, under penalty of perjury, the following:
a. Do you currently have a child-support obligation? Yes No
(1) If “Yes,” are you in arrears in payment of said obligation? Yes No
(2) If “Yes,” does the arrearage match or exceed the total amount payable for the past six months?
Yes No
b.
Have you failed to provide any court-ordered health insurance coverage during the past six months?
Yes No
c.
Have you failed to respond to a subpoena relating to either a paternity or child-support proceeding?
Yes No
d. Are you the subject of a child-support-related arrest warrant? Yes No
In accordance with N.J.S.A. 2A:17-56.44d, an answer of “Yes” to any of the questions a(1) through d will result in a denial
of reinstatement of licensure or registration. 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 registration.
_________________________________ __________________________________________ ___________________
Applicant’s name (please print)  Applicant’s signature  Date
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signature
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6. Have you ever changed your name? Yes No
If “Yes,” please submit with this application a copy of the marriage certicate, divorce decree or court order.
7. 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 oense, 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
8. Have you ever been convicted of any crime or oense 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.)
9. 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 dierent 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/expire
10. 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
11. 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
12.
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
13. Have you ever been named as a defendant in any litigation related to the practice of plumbing or other professional
or occupational practice in New Jersey, any other state, the District of Columbia or in any other jurisdiction?
Yes No
14. Are you aware of any investigation pending against a professional or occupational 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
15. 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
16. 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 plumbing or other professional or occupational practice in New Jersey, any other state, the
District of Columbia or in any other jurisdiction? Yes No
If the answer to any of the above questions, numbers 10 through 16, 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
____________________________________________________________________________________________________________
City State ZIP code
Immediate supervisor’s name: __________________________________________________________________________________
Employer’s telephone number:_______________________________ Hours per week: ___________________________________
(Include area code)
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
____________________________________________________________________________________________________________
City State ZIP code
Immediate supervisor’s name: __________________________________________________________________________________
Employer’s telephone number:_______________________________ Hours per week: ___________________________________
(Include area code)
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
____________________________________________________________________________________________________________
City State ZIP code
Immediate supervisor’s name: __________________________________________________________________________________
Employer’s telephone number:_______________________________ Hours per week: ___________________________________
(Include area code)
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
Yes
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Continuing Education Credits Earned
Individuals applying to reinstate a license as a master plumber are required to show that they have completed five (5) credit
hours of continuing education. Submit copies of all continuing education certificates earned along with this application.
Date of course Name of sponsor Title of program Number of credits
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
_____________________ _____________________________ __________________________________ ___________
CertifiCation for reinstatement appliCation
I, ________________________________________________ , in making this application to the Board or Committee for
reinstatement of my license or registration, 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 sufficient to deny reinstatement or to withhold renewal of or suspend or revoke
a license or registration 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 qualifications for reinstatement. I further authorize all institutions, employers, agencies and all
governmental agencies and instrumentalities (local, state, federal or foreign) to release any information, files 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
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Instructions for Reinstating a License as a Master (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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