Motor Vehicle Commission Business Licensing Services Bureau P.O. Box 168 Trenton, New Jersey 08666-0168 P:609-292-6500 x5094 DRIVING SCHOOL - INITIAL INSTRUCTORS LICENSE APPLICATION FEE: $75.00 Instructor License Number D.L.Check Expires To be submitted to Motor Vehicle Services for the purpose of securing approval to engage in motor vehicle driving instructions by an owner, officer or employee (full or part-time) in connection with a driving school license pursuant to the provisions of 39:12 R.S. ALL APPLICANTS ARE REQUIRED TO PASS A KNOWLEDGE TEST, VISION TEST, DRIVING INSTRUCTION TEST AND JUDGMENT OF DRIVING ABILITY TEST GIVEN BY MOTOR VEHICLE SERVICES, AND ARE REQUIRED TO SUBMIT TO FINGERPRINTING. The Instructor applicant will complete both sides of this application. Date Print Name Telephone No. Resident Address (Street) (City) (State) (Zip Code) PERSONAL DESCRIPTION: Height Weight Date of Birth Any Permanent physical marks? Yes No- Do you possess a current N.J. Driver’s License? Color Eyes If so, describe Yes No ­ Expiration Date N.J. Driver License No. Have you held a N.J. Driver License for the last four consecutive years? Yes No If no, give residence address in state where you were previously licensed NOTE: You must submit a certified abstract of your driving record if the state of licensure is other than New Jersey, and a copy of your Drivers License. Has your driver license privilege ever been suspended or revoked in this or any other state? Yes No If yes, give particulars Name of Driving School Address of Driving School (Street) State your position with driving school. Owner (State) (City) Partner Officer Employee BLC-84 (R 9/08) American LegalNet, Inc. www.FormsWorkFlow.com Have you ever applied for a Driving School Instructor License, or Driving School License in this or any other state? Yes No Have you ever been denied a driver’s license, a driving instructor license or a driving school license in this or any other state? Yes- No- If yes, give particulars Have you ever been convicted of inducing another to resort to fraud or fraudulent practices in relation to securing a license to drive a motor vehicle or motorcycle? Yes- No If yes, give particulars Have you ever been arrested for, charged with, indicted for or convicted of any of the offenses enumerated in 13:23-2.12? Yes No If yes, give particulars CIVIL AND FEDERAL OFFENSE HISTORY (INCLUDING COURT MARTIAL) (RECORD ALL ARRESTS AND CONVICTIONS) Date Offense Court Disposition Penalty I, THE UNDERSIGNED, DECLARE THAT I AM THE APPLICANT NAMED HEREIN, KNOW THE CONTENTS OF THIS APPLICATION, AND CERTIFY THE CONTENTS HEREIN TO BE TRUE. (Signature of Applicant) (Date) SCHOOL OWNER’S STATEMENT OF CONSENT I am the owner, or partner or officer of the Driving School listed herein, and believing the information given herein is true, hereby endorse consent in the issuing of an instructor license to the applicant. (Signature) (Title) (Date) Initial instructor applicants are required to submit to tests prescribed by the Chief Administrator to determine that they possess the minimum qualifications for licensing. 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-1­ 800-673-0353 (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 (3) Statute Number MVK NJ920530Z 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 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? No Yes 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 New Jersey Motor Vehicle Commission Trenton, New Jersey 08666 STATE OF NEW JERSEY (888) 486-3339 ext.5094 toll-free in NJ (609) 292-6500 ext.5094 May 10,2001 TO: ALL DRIVING SCHOOLS All applicants who wish to obtain an initial Driving School Instructor's license may do so on a walk in basis between the hours of 8:00 am and 11:00 am at the following Driver Testing Centers. EATONTOWN TRENTON RAHWAY WAYNE 1. All items listed on the attached checklist must be mailed to Business License Compliance Driving School Unit POB 168 Trenton, New Jersey 08666 prior to the applicant(s) appearing for the tests. 2. Written and vision test will be administered when applicant appears at the Driver Testing Center. 3. Scheduling of the road test will be made by the Driver Testing Center after the vision and written testing phase has been successfully completed. The road test may be scheduled the same day if time and staffing allows. If the road test schedule is full, the test will be scheduled on the next available day. 4. The permanent license will not be issued until we receive the results of the instructor test and fingerprint check. BUSINESS LICENSING SERVICES BUREAU Driving School Section American LegalNet, Inc. www.FormsWorkFlow.com