Fillable New Jersey Division of Fish and Wildlife Hunter

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New Jersey Division of Fish and Wildlife Hunter

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1
New Jersey Division of Fish and Wildlife
Hunter Education Instructor Application
Name: ________________________________ Date of Birth: ___/___/___ Age: ______
Address: ___________________________ City: ____________________ State: ____ Zip: ________
County: ____________________________ Social Security #:_____________________
Telephone: Evening: (____)___________ Day: (____)__________ Ext: _____
*NJ Firearms Purchaser ID Card #: __________________ Year Issued: ____________
Valid New Jersey Driver License #: ________________________ List if another state: ______
Education: *High School Diploma or GED: ☐ Yes ☐ No
College Degree: ☐ No ☐ Yes: _______ or Years Completed: ☐ 1 ☐ 2 ☐ 3 ☐ 4
Major: ________________________________________________
New Jersey Hunter Education Courses (List all completed):
_______Shotgun Year: _______ County: ________________
_______Archery Year: _______ County: ________________
_______Rifle/Muzzleloader Year: _______ County: ________________
_______Firearms Year: _______ County: ________________
Employer: _______________________________________ Title: ________________________
Work Address: _______________________________________________________________
Major responsibilities: _________________________________________________________
_______________________________________ Length of Employment: _____________
References
: (List those, other than relatives, who can attest to your character, hunting activities and other qualities)
1. Name: __________________________________ Day phone: (____)___________ Ext.: _____
Address: ____________________________________________________________________
2. Name: __________________________________ Day phone: (____)___________Ext.: _____
Address: ____________________________________________________________________
3. Name: __________________________________ Day phone: (____)___________Ext.: _____
Address: ____________________________________________________________________
* Required of all Hunter Education instructor applicants
2
Hunter Education Instructor Application (page 2)
Select the Hunter Education course(s) that you would like to teach.
☐Firearms ☐ Archery ☐ Trapper Education
List any license, certification, registration, special training or skill that you possess which may be useful
when teaching Hunter Education courses. Include such items as First Aid, CPR; list expiration dates if
applicable:
______________________________________________________________________________
______________________________________________________________________________
_____________________________________________________________________________
What experience do you have that will be of value to the Hunter Education Program?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
State your reasons for wanting to become a Hunter Education instructor:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Please check all of the sporting activities in which you are active:
Bow Hunting Firearm Hunting Fishing Recreational Shooting
☐
Deer ☐ Deer ☐ Saltwater ☐ Trap or Skeet
☐ Small game ☐ Small game ☐ Freshwater ☐ Sporting Clays
☐ Turkey ☐ Waterfowl ☐ Bowfishing ☐ Muzzleloader
☐ Bear ☐ Turkey ☐ Modern Rifle
☐ Bear ☐ Target archery
3
Hunter Education Instructor Application (page 3)
List your membership in any sporting organization(s): __________________________________
______________________________________________________________________________
Note any restrictions or commitments which may affect your availability: ___________________
______________________________________________________________________________
Have you ever been arrested, convicted, or indicted for a criminal offense? ☐ No ☐ Yes
If yes, state disposition, municipality and date: ________________________________________
______________________________________________________________________________
Have you ever been issued a summons, arrested or convicted of a Fish & Wildlife violation:
☐ No ☐ Yes Year _____
Identify any physical or medical conditions (including allergies and medication which you take) that
might affect your activities or which should be brought to the attention of the Division of Fish and
Wildlife to enable them to provide information should you need treatment in any emergency situation.
Disclosure of this information will not disqualify you from volunteer service. (Be sure to inform your
fellow instructors when you work with a team.)
______________________________________________________________________________
______________________________________________________________________________
Applicants will be required to successfully complete New Instructor Training, including orientation
materials, Policy and Procedures manual review, and successful completion of a written or oral instructor
examination and Live Firing Training. Applicants are subject to a background check to verify
information. All instructors are required to attend a minimum of one seminar or workshop each year and
continue to teach annually in order to maintain active instructor status. For further information call the
hunter education office at 856-629-0552.
Signature: ____________________________________ Date: ________________
Mail completed application to:
NJ Division of Fish & Wildlife
Hunter Education
220 Blue Anchor Rd.
Sicklerville, NJ 08081
DO NOT WRITE BELOW THIS LINE
……………………………………………………………………………………………………….
_______________________
Date received _______________________ Background check
_______________________
New Instructor Training _______________________ Live Firing Training
_______________________
Team Assignment _______________________ Instructor Exam Score
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New Jersey Division of Fish and Wildlife Hunter

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Completed 13 May 2021

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