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Click ‘Get Form’ to open the New Jersey SP 171 form in the editor.
Begin by filling in your personal information, including your name, home address, and contact details. Ensure accuracy as any misstatement can lead to denial.
Select the appropriate license type by checking the corresponding box. This is crucial for determining your eligibility.
Provide details about your agency or trade name, including its current or proposed address. If applicable, include a mailing address that differs from your agency's address.
Attach a recent full-face photograph and complete sections regarding your employment history and references. Make sure all references are reputable citizens over 21 years old.
Review all fields for completeness before submitting. Utilize the continuation page if you need additional space for any questions.
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Any person who shall knowingly state any fact falsely shall be guilty or a misdemeanor - NJS 45:19-11. SP-171 (Rev. 12/00). NAME (Print Last). (First).Read more
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45:19-9 shall file an application with the Superintendent on a form designated S.P. 171 and accompanied by any documents required by such application. (b)
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