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

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

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New Jersey Is An Equal Opportunity Employer • Printed on Recycled Paper and Recyclable
New Jersey Ofce of the Attorney General
Division of Consumer Affairs
New Jersey State Board of Architects
124 Halsey Street, 3rd Floor, P.O. Box 45001
Newark, New Jersey 07101
(973) 504-6385
Instructions for
Reinstatement of License
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,
certication and complies with the provisions of the Uniform Enforcement Act N.J.S.A. 45: 1-7.1a, b,
c, d and e, and N.J.S.A. 45: 1-7.2a, b, c and d. The necessary application and materials for applying
for reinstatement are enclosed.
1. Complete:
• The enclosed application for reinstatement.
2. Enclose:
• Payment of all past delinquent renewal fees and/or payment of a current renewal fee;*
• Payment of a reinstatement fee.*
* See the enclosed cover letter for the fees and continuing education hours required.
• A licensee whose license has been automatically suspended for ve (5) years or less
for failure to renew pursuant to N.J.A.C. 13:27-4.6(d) may be reinstated by the Board
upon completion of the following:
a. Payment of the reinstatement fee and all past delinquent biennial renewal fees as
set forth in N.J.A.C. 13:27-4.11;
b. Submission of proof of completion of the continuing education credits required for
each biennial licensure period for which the license was suspended; and
c. Submission of an afdavit of employment listing each job held during the period
of suspended license which includes the name, address and telephone number of
each employer.
• In addition to fullling the requirements set forth in N.J.A.C. 13:27-4.6(e), a licensee
whose license has been automatically suspended for more than ve (5) years who wishes
to return to practice shall reapply for licensure and shall demonstrate that he or she has
maintained prociency. An applicant who fails to demonstrate to the satisfaction of the
Board that he or she has maintained prociency while the license was lapsed may be
subject to an examination or other requirements as determined by the Board prior to
reinstatement of his or her 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
New Jersey State Board of Architects
124 Halsey Street, 3rd Floor, P.O. Box 45001
Newark, New Jersey 07101
(973) 504-6385
Application for Reinstatement
You may not practice in the State of New Jersey until your license has been reinstated.
Date: ______________________________
Along with the submission of this completed application, all fees must be paid in the form of a check or
money order made out to the State of New Jersey. (Applicants should understand that if fee is paid with a
personal check, and the check is returned by the bank due to insufcient funds, the next step in the licensure or
certication 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 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
Place of birth: _______________________
City State
Mr.
1. Name Mrs. ________________________________________________________________ ( _______________________)
Ms.
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)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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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yourimmigrationstatusandwhetherornotitisaqualifyingstatusunderfederal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,”youmustobtaindocumentaryevidencethatyouhavereachedanarrangementwiththebankorwiththeentitythatissued
yourstudentloan,fortheeventualrepaymentoftheloan.Youwillnotbeabletoobtainalicenseorcerticate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,”doesthearrearagematchorexceedthetotalamountpayableforthepastsixmonths? Yes No
b. Haveyoufailedtoprovideanycourt-orderedhealthinsurancecoverageduringthepastsixmonths? Yes No
c. Haveyoufailedtorespondtoasubpoenarelatingtoeitherapaternityorchild-supportproceeding? 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
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 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
8. 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.)
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 different name, please provide that name.
_____________________ _______________________ ____________________________ ____________________
State or jurisdiction that issued the license or certicate Date issued/expiredType of license or certicate Number
_____________________ _______________________ ____________________________ ____________________
State or jurisdiction that issued the license or certicate Date issued/expiredType of license or certicate Number
_____________________ _______________________ ____________________________ ____________________
State or jurisdiction that issued the license or certicate Date issued/expiredType of license or certicate Number
_____________________ _______________________ ____________________________ ____________________
Number State or jurisdiction that issued the license or certicate Date issued/expiredType of license or certicate
10. Have you ever been disciplined or denied 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
11. Have you ever had a professional 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 practice
by any agency or certication 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 architecture or other professional 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 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 architecture or other professional 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 7 through 16, is “Yes,” provide a complete explanation of the
circumstances leading to the action, and any supporting documentation, on separate sheets of paper.
__________________________________________________________________
First name Middle initialLast name
Type of license ________________________________________ N.J. license number ____________________________________
Initial license date _____________________________________ Date of last renewal ___________________________________
Answer the following questions for the time period since you were last licensed in New Jersey.
1. Have you completed the required continuing education requirements for all the lapsed biennial periods? Yes No
If “No,” please submit your explanation for not completing the continuing education requirements.
2. Are you currently practicing architecture as a sole proprietorship? Yes No
If “No,” please indicate your type of practice:
L.L.C. L.L.P. Consultant Employee
Partnership General Business Corporation Professional Service Corporation
3. Is any action now pending against your professional license or have you been permitted to surrender or otherwise relinquish
your license to avoid inquiry, investigation or action by any state licensing board? Yes No
If “Yes,” please provide a detailed explanation and any documentation, e.g. a copy of the disciplinary action taken by the
state licensing board.
You may attach additional sheets of paper to this application in order to respond to the preceding questions.
Note
All requests for reinstatement must be submitted in writing along with a notarized statement that includes the following:
a. An explanation of your failure to renew promptly.
b. A list of the New Jersey projects you signed and sealed after the license had lapsed, including the names and addresses
of the projects and the dates the architectural services commenced and concluded; or
c. If no New Jersey projects were completed, a notarized statement certifying that no work was signed and sealed after
the license had lapsed.
d. Payment of a reinstatement fee for the current biennial period and the appropriate renewal fees for all previous
biennial periods during which the license was expired.
e. Proof of completion of the Continuing Education (C.E.) hours required for each biennial licensure period during which
the license was expired.
Please attach additional pages to this application to respond to a, b and c above.
AffidAvit
This afdavit is to be executed by the applicant before a notary public:
State of _____________________________________________
County of ___________________________________________
I, ________________________________________________ , in making this application to the New Jersey State Board of Architects
for licensure as an Architect under the provisions of Title 45 of the General Statutes of New Jersey and the Rules of the New
Jersey State Board of Architects, swear (or afrm) that I am the applicant and that all 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 licensure or to withhold renewal of or suspend or revoke a license issued by
the Board.
I further swear (or affirm) that I have read N.J.S.A. 45:3A-1 et seq., together with the Rules and Regulations of the
New Jersey State Board of Architects, N.J.A.C. 13:27-8.1 et seq., and fully understand that in receiving licensure from the Board,
I bind myself to be governed by them.
Furthermore, 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 licensure. 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.
_________________________________________________
Signature of applicant
Sworn and subscribed to before me this ________________
day of ____________________________ , ______________
Month Year
__________________________________________________
Name of Notary Public (please print)
__________________________________________________
Signature of Notary Public
} ss.
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Reinstatement of License (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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