Motor Vehicle Commission Business Licensing Services Bureau PO Box 168 Trenton, New Jersey 08666- 0168 Phone: (609) 292-6500 ext. 5094 Initial - Renewal ; expiration date Secondary school driver education instruction # Please print or type Social Security Number Applicant’s Name Address street crty Driver License Number state, zip Issuing state (name and address of employing or contracting secondary school) If you provide driver education at another secondary school, please specify its name here: applicant’s signature date This is to certify that the person named above is employed/contracted by to teach secondary school driver education. name of school principal’s signature date A public school teacher’s initial application must be accompanied by a copy of a valid New Jersey Standard Certificate for Teacher of Driver Education; all applications must include the secondary school principal’s countersignature. A private or parochial school teacher’s initial application must include proof of successful completion of a Department of Education-approvedthree-credit course in driver education-teacher certification; all applications must include the secondary school principal’s countersignature. A contracted driving school instructor’s initial application-one per school-must include proof of a current service contract with a secondary school and proof of successful completion of a Department of Educationapproved three-credit course in driver education-teacher certification. A renewal application must be submitted with proof of a current service contract with a secondary school. All applications must include the secondary school principal’s countersignature. A non-resident driver must submit a current driver history abstract from his/her home state,and a copy of their Drivers License. Mail this application with all accompanying material to the address shown above. BLC-36 (R 9/08) MVC Web Site http://www.njmvc.gov American LegalNet, Inc. www.FormsWorkFlow.com