Business Licensing Services Bureau P.O. Box 168 Trenton, New Jersey 08666-0168 609-292-6500 ext.5094 Commission "AUTHORIZED AGENT" APPLICATION - DRIVING SCHOOL DL Check Initial Renewal Phone No. Name (Print) Address City, State, Zip Code Age Date of Birth Height Weight Color of Hair Color of Eyes Driver’s License No. Expires State of Licensure Driving School by whom you are to be employed Answer the following questions: 1. Have you ever been arrested for, charged with, indicted for or convicted of any of the offenses If “yes” explain. enumerated in 13:23-2.12? 2. Have you ever had your driving privileges suspended or revoked in this or any other state? If “yes” explain. 3. Have you ever been refused a drivers license in this or any other state? SIGNATURE OF APPLICANT If “yes” explain. DATE BLC-82 (R 9/08) American LegalNet, Inc. www.FormsWorkFlow.com The following is to be completed by Driving School Owner. I hereby certify that the applicant here named is applying with my authorization, for approval to act as an “Authorized Agent” for the Driving School. It is understood that the “Authorized Agent” shall be permitted to transport the school’s students to a Driver Testing Center to take the driving test portion of the driver’s examination or to purchase a permit. SIGNATURE OF SCHOOL OWNER, PARTNER OR OFFICER DATE: INSTRUCTIONS TO APPLICANT This application must be accompanied by: 1. A certified abstract of your driving record from the Driver’s Licensing State if other than New Jersey (initial and renewal), and a copy your Drivers License. 2. FEE. $25.00 (one year period). Check or money order made payable to NJ Motor Vehicle Commission or NJMVC Business License Compliance. This application is to be submitted to Motor Vehicle Commission, Business License Services, P.O. Box 168, Trenton, New Jersey 08666-0168. American LegalNet, Inc. www.FormsWorkFlow.com Business Licensing Services Bureau P.O. Box 171 Trenton, New Jersey 08666-0171 (609) 292-6500 #5014 _______________________________________________________________________________________ CHILD SUPPORT CERTIFICATION FORM _________________________________________ Business Name _________________________________________ Applicant’s Name (Print) __________________ Date of Birth _________________________________________ Social Security Number Under the provisions of N.J.S.A. 2A:17-56.7 et seq., responses to the questions listed below are required. Misstatements will be just cause to take administrative action including, but not limited to, denial of licensure, immediate suspension or revocation of the license. 1. Do you have a child support obligation? Yes No 2. If yes, do the arrearage amounts equal or exceed the amount of child support payable for six months? Yes No 3. Are you subject to a child-support warrant? Yes No I certify that the foregoing responses made by me are true and I am aware that the making of false statements may subject me to contempt of court. ______________________________________________ __________________ Signature Date BLS-43 (R 9/09) On the Road to Excellence www.njmvc.gov New Jersey is an Equal Opportunity Employer American LegalNet, Inc. www.FormsWorkFlow.com Motor Vehicle Commission Trenton, New Jersey STATE OF NEW JERSEY BUSINESS LICENSING SERVICES BUREAU TO ALL AUTHORIZED AGENTS AND INSTRUCTORS The New Jersey Motor Vehicle Commission has now established a live fingerprint scan process to streamline criminal background checks required as a condition of licensure. As part of the Business License application process, it is required that all applicants, authorized agents or driving school instructors, proprietors, partners and corporate officers, schedule an appointment with the States private fingerprint scan vendor MorphoTrak (formerly Sagem Morpho, Inc.). All you need do is call this toll free number 1-877-503-5981 (English or Spanish Operators) or TTY-1800-673-0353 (HEARING IMPAIRED Modem Required) to arrange an appointment to be scanned at an established site. When scheduling your appointment, you will be asked to provide certain personal information including your driver’s license and social security number. Please make sure you have this information available when scheduling your appointment. In addition, you will be asked to provide the following Motor Vehicle Commission identification numbers: ORIGINATING AGENCY REFERRAL NUMBER (ORI) AGENCY CASE NUMBER CATEGORY DOCUMENT TYPE STATUTE 39:12-5 and 6 NJ920530Z (Your Driver License Number) MVK RB 1 COMMERCIAL DRIVING SCHOOL LICENSE Please complete the applicant information form contained on the back of this letter. Though certain information is already filled in, you will need to supply certain personal information in blocks 9 through 26 as well as your driver’s license number in block 7 which will be used as your agency case number. Please have this form filled in and present it when you appear for your appointment along with the proper photo identification as noted on the back of this letter. After supplying this information you will be scheduled for an appointment at one of the electronic scan sites. You will be required to pay a one-time fee in the amount of $70.25 incorporating all required background checks. Payment must be made at the time of scheduling your appointment. AT THE TIME OF SCANNING YOU WILL RECEIVE A RECEIPT FROM THE STATE’S VENDOR. PLEASE SUBMIT THIS RECEIPT OR A COPY THEREOF AS PART OF YOUR BUSINESS LICENSE APPLICATION PACKAGE. If you have any questions concerning this procedure, please contact the following area: NEW JERSEY MOTOR VEHICLE COMMISSION BUSINESS LICENSING SERVICES BUREAU DRIVING SCHOOL LICENSING SECTION 609-292-6500 ext.5094 PLEASE BRING THIS LETTER AND PHOTO IDENTIFICATION WITH YOU WHEN YOU APPEAR TO BE FINGERPRINTED REV 9/09 American LegalNet, Inc. www.FormsWorkFlow.com . www.bioapplicant.com/nj Formerly Sagem Morpho Inc (1) Originating Agency Number (ORI #) (2) Category NJ920530Z (3) Statute Number MVK 39:12-5, 6 (4) Reason for Fingerprinting (5) Document Type RB1 COMMERCIAL DRIVING SCHOOL LICENSE (7) Contributor’s Case # (Unique Identifier) INSTRUCTORS LICENSE (9) First Name (10) MI (12)Daytime Phone Number ) $70.25 (8) Miscellaneous DL# ( (6) Payment Information (13) Social Security Number (11) Last Name (14) Date of Birth (15) Height (16) Weight - (17) Maiden Name (if married female) (18) Place of Birth (U.S. State –for US Citizen; Country for all others) (19) Country of Citizenship (20) Home Address Address (21) Gender (Select one) (22) Hair Color (Indicate most predominant color, one only) Male ( ) Female ( ) Both ( ) (25) Occupation City (23) Eye Color State Zip (24) Race (Select One) A Asian/ Pacific Islander ( includes Asian Indian) B Black W White ( Includes Hispanic/ Spanish Origin) U Unknown I American Indian / Alaska Native (26) Employer (Name) Employer Address City State Zip APPLICANT INFORMATION – READ THIS FORM CAREFULLY AND FOLLOW ALL INSTRUCTIONS TO COMPLETE THE FINGERPRINT PROCESS. You MUST present this completed form at your appointment to be FINGERPRINTED. NO EXCEPTIONS ALLOWED. Applicants without forms or with incomplete forms will not be printed. IDENTIFICATION IS REQUIRED- ACCEPTABLE ID REQUIREMENTS –ID MUST include Photo, Name, Address (Home/ Employer) and Date of Birth. Acceptable ID MUST be issued by a Federal, State, County or Municipal entity for Identification purposes. Examples of acceptable ID are: 1) Valid Photo Drivers License or Valid Photo ID issued by any State DMV or NJ MVC, 2) Passport. Acceptable ID MUST meet all of the underlined requirements above and MUST be present on one (1) ID. Combinations of documents are NOT acceptable. If acceptable ID is not presented you will not be fingerprinted. For applicants who are required to pay for their own fingerprinting fees, payment is required at the time of scheduling. Payment may be made with a credit card or electronic debit from a checking account. Remember your account will automatically be debited. An $11 fee is charged to cover the cost of a scheduled appointment for applicants who do not cancel/reschedule by noon on the business day prior to your scheduled appointment (Saturday noon for Monday appointments). All appointments can be canceled/rescheduled via the web without penalty if cancellation requirements are met. The $11 fee will also apply for applicants who are turned away from the printing sites due to the inability to present proper ID, who fail to present this completed Universal Fingerprint Form provided to you by your requesting agency or employer, or who are turned away because information on this form does not match the information provided during the scheduling process. You will be refunded State and Federal search fees only. Appointment scheduling is available via the web at www.bioapplicant.com/nj, 24 hours per day, 7 days per week. For applicants who do not have web access, appointments can be made by contacting us toll free at (877) 503-5981 on a first call, first served basis Monday through Friday, 8:00 AM to 5:00 PM EST and Saturday, 8:00 AM to 12 noon EST. English and Spanish speaking operators are available. Hearing impaired scheduling is available at (800) 673-0353. ONLY applicants who schedule through the call center can make payment by money order at the fingerprint site. No other form of payment is accepted at the fingerprint site. Your APPLICANT ID, Site, Date, Time of your appointment, and payment authorization will be confirmed by the call center agent or web confirmation when scheduling is complete. You must record this information in the appropriate blocks below while speaking with the operator. If you appear for fingerprinting at a site where you are not scheduled or on a different date and time, you will be turned away and not fingerprinted. If applicable, you may incur the $11 appointment fee. Your PCN number will be recorded when your fingerprinting has been completed. You MUST retain a copy of the form and a copy of the receipt provided to you by the Fingerprint Technician for your records. NO RECEIPTS WILL BE PROVIDED AFTER THE DATE OF PRINTING. Applicant ID No. Scheduled Site/ Date/ Time Agency Information #1 PYMT Authorization PCN Agency Information #2 APPLICANTS MUST NOT ALTER, SHARE, OR REUSE THIS FORM FORM NO. NJAPS2, Version 4.0 September 1, 2009 American LegalNet, Inc. www.FormsWorkFlow.com