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

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Instructions for Reinstating a Registration (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
Board of Examiners of Electrical Contractors
124 Halsey Street, 6th Floor, P.O. Box 45006
Newark, New Jersey 07101
(973) 504-6410
Instructions for Reinstating a Registration
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 qualifies for licensure, registration
or certification 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.
2. Enclose with your completed application:
-
Certificate(s) of Completion for Continuing Education - proof that the applicant has maintained
prociency by completing the mandatory continuing education hours required for the renewal of
a registration. Ten (10) credit hours of Continuning Education on the most recent edition of the
National Electrical Code for the current triennial registration period within three (3) years prior
to the date of the application for 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 13:31-1.6 Fee Schedule
Registration Reinstatement Fee
Year Registration Lapsed Total Fee Due
Previous Cycle $160.00
N.J.A.C. 13:31-5.2 Registration Renewal, Suspension or Reinstatement
(a) A Qualied Journeyman Electrician shall renew his or her certicate of registration for a period of three
years from the last expiration date. The Qualied Journeyman Electrician shall remit a renewal application
to the Board, along with the renewal fee set forth in N.J.A.C. 13:31-1.6, prior to the date of registration
expiration. A Qualied Journeyman Electrician who submits a renewal application within 30 days following
the date of registration expiration shall submit the renewal fee, as well as the late fee set forth in N.J.A.C.
13:31-1.6. A Qualied Journeyman Electrician who fails to submit a renewal application within 30 days of
registration expiration shall have his or her certicate of registration suspended without a hearing.
(b) A Qualied Journeyman Electrician who has had his or her certifcate of registration suspended pursuant
to (a) above may apply to the Board for reinstatement within ve years following the date of certicate of
registration expiration. A Qualied Journeyman Electrician applying for reinstatement shall submit a
renewal application, all past delinquent renewal fees and the reinstatement fee set forth in N.J.A.C.
13:31-1.6, as well as evidence of having completed all continuing education credits, consistent with the
requirements set forth in N.J.A.C. 13:31-5.4, for the current triennial registration period within three years
prior to the date of application for reinstatement.
Note: If the year that your registration expired is not listed above, please contact the Board for further instructions.
4. Submit all documents to: Board of Examiners of Electrical Contractors
P.O. Box 45006
Newark, NJ 07101
The fees are calculated based on the fee for each triennial
cycle that has occurred since the certicate of registration
has lapsed, plus a reinstatement fee of $100.00 which is
already included in the total fee due noted above.
New Jersey Office of the Attorney General
Division of Consumer Affairs
Board of Examiners of Electrical Contractors
124 Halsey Street, 6th Floor, P.O. Box 45006
Newark, New Jersey 07101
(973) 504-6410
Application for Reinstatement of a Registration to
Practice as a Qualied Journeyman Electrician
Date : _______________________________
Qualified Journeyman Electrician Registration No.:____________________ Initial Registration Date: ______________________
A nonrefundable reinstatement fee of $100.00, along with a $60.00 registration fee for the current triennial registration period,
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Number
IfyouwereissuedaSocialSecurityNumberoranIndividualTaxpayerIdenticationNumber,youmustprovideittothe
BoardorCommittee.Failuretodosomayresultindenialoflicensure/certication/reinstatement/reactivation.
*SocialSecurityNumber: __________-__________-__________
*IndividualTaxpayerIdentication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
EnforcementLaw,Section1128E(b)(2)AoftheSocialSecurityActand45C.F.R.60.7,60.8and60.9,theBoardorCommittee
isrequiredtoobtainthisinformation.Pursuanttotheseauthorities,theBoardorCommitteeisalsoobligatedtoprovidethis
informationto:
(For healthcare-related boards, the following a, b and c entries apply. For boards not related to healthcare, only the a and
b entries apply.)
 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anAmericancitizen, please enclosea copyofyourbirthcerticate orU.S.passport. If youare not
aU.S.citizen,attachacopyofyouralienregistrationcard(frontandback)orotherdocumentationissuedbythe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statusandwhetherornotitisaqualifyingstatusunderfederallawshould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mustobtaindocumentaryevidencethatyouhavereachedanarrangementwiththebankorwiththeentitythatissued
yourstudentloan,fortheeventualrepaymentoftheloan.Youwillnotbeabletoobtainalicenseorcerticateunlessyouprovidethe
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matchorexceedthetotalamountpayableforthepastsixmonths? Yes No
b. Haveyoufailedtoprovideanycourt-orderedhealthinsurancecoverageduringthepastsixmonths? Yes No
c. Haveyoufailedtorespondtoasubpoenarelatingtoeither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throughdmayresultin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
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signature
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7. Have you ever changed your name? Yes No
If “Yes,” please submit with this application a copy of the marriage certificate, divorce decree 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 finding 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 certificate 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 certificate held, provide the date(s) held and the number(s). If the license or certificate was issued under
a different name, please provide that name. _________________________________________________________________
Last name First name Middle initial
_____________________ _______________________ ____________________________ ____________________
Type of license or certificate Number State or jurisdiction that issued the license or certificate Date issued/expired
_____________________ _______________________ ____________________________ ____________________
Type of license or certificate Number State or jurisdiction that issued the license or certificate Date issued/expired
_____________________ _______________________ ____________________________ ____________________
Type of license or certificate Number State or jurisdiction that issued the license or certificate Date issued/expired
_____________________ _______________________ ____________________________ ____________________
Type of license or certificate Number State or jurisdiction that issued the license or certificate Date issued/expired
_____________________ _______________________ ____________________________ ____________________
Type of license or certificate Number State or jurisdiction that issued the license or certificate Date issued/expire
11. Have you ever been disciplined or denied a professional or occupational license or certificate 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 certificate 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 or occupational practice
by any agency or certification 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 a Qualified Journeyman Electrician 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 certificate 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 a Qualified Journeyman Electrician 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 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.
Employment since your Certificate of Registration 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 Qualified Journeyman Electrician’s Certificate of Registration are required to show that
they completed 10 credit hours of continuing education on the most recent edition of the National Electrical Code. Please
list the courses completed below. Submit copies of the 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 Registration (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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