Fillable Professional Reference Form (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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Professional Reference Form (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
New Jersey State Board of Architects
Interior Design Examination and Evaluation Committee
124 Halsey Street, 3rd Floor, P.O. Box 45001
Newark, New Jersey 07101
(973) 504-6385
Professional Reference Form
for Certication as an Interior Designer
I. Section to be completed by Applicant:
Date:__________________________
TheNewJerseyStateBoardofArchitects’InteriorDesignExaminationandEvaluationCommitteehasreceivedanapplicationfor
certication in Interior Design from _____________________________________________________________ of
Applicant’sname
______________________________________________________________________________________________
Applicant’saddress

City State ZIPCode
II. Section to be completed by Reference:
Theabove-namedapplicanthasappliedforcerticationundertheInteriorDesignCerticationActandhasidentied
youasapotentialreference.Issuingcerticationtoqualiedinteriordesignerssafeguardsthepublic’shealth,safetyand
welfare,maintainsahighprofessionalstandard,andpermitstheapplicanttoutilizethetitle“CertiedInteriorDesigner.”
Pleasegivecomplete,accurateanswerstothefollowingquestions.Pleaseindicate“NA”inresponsetoanyquestion
whichyoudonotfeelqualiedtoanswer.
Reference’sname:_________________________________________ Telephonenumber:____________________
(includeareacode)
Reference’saddress:_____________________________________________________________________________
Streetaddress
_____________________________________________________________________________________________
City State ZIPCode
Reference’stitleandoccupation:_______________________ License/Certicatenumber:____________________
1. Listanyadditionalprofessionallicenses/certicationswhichyouhold(ifapplicable):
__________________________________________________________________________________________
Type(profession)  State License/Certicatenumber
__________________________________________________________________________________________
Type(profession)  State License/Certicatenumber
2. Howlonghaveyouknowntheapplicant?_________________________________________________________
3. Inwhatcapacityhaveyouknowntheapplicant?___________________________________________________
4. Do you have any reason to doubt the moral character of the applicant?  Yes No
If “Yes,” please explain._______________________________________________________________________
__________________________________________________________________________________________
5. Please provide any additional information which you would like the Committee to consider in connection with the
applicant.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Please put a check on the performance level the applicant has exhibited in interior design services in each of the
following areas of interior design.
Preparation of drawings Satisfactory Unsatisfactory Unknown/Not Applicable
Administration of drawings Satisfactory Unsatisfactory Unknown/Not Applicable
Preparation of schedules Satisfactory Unsatisfactory Unknown/Not Applicable
Administration of schedules
Satisfactory Unsatisfactory Unknown/Not Applicable
Preparation of specications
Satisfactory Unsatisfactory Unknown/Not Applicable
Administration of specications Satisfactory Unsatisfactory Unknown/Not Applicable
Furnishings Satisfactory Unsatisfactory Unknown/Not Applicable
Layouts Satisfactory Unsatisfactory Unknown/Not Applicable
Non-load bearing partitions
Satisfactory Unsatisfactory Unknown/Not Applicable
Fixtures
Satisfactory Unsatisfactory Unknown/Not Applicable
Cabinetry Satisfactory Unsatisfactory Unknown/Not Applicable
Lighting location and type Satisfactory Unsatisfactory Unknown/Not Applicable
Outlet location and type Satisfactory Unsatisfactory Unknown/Not Applicable
Switch location and type
Satisfactory Unsatisfactory Unknown/Not Applicable
Finishes
Satisfactory Unsatisfactory Unknown/Not Applicable
Materials Satisfactory Unsatisfactory Unknown/Not Applicable
Interior construction not materially related Satisfactory Unsatisfactory Unknown/Not Applicable
to or materially affecting the building systems
   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 Date
Return form promptly to: New Jersey State Board of Architects
Interior Design Examination and Evaluation Committee
124 Halsey Street
P.O. Box 45001
Newark, NJ 07101
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Professional Reference Form (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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