Get Duplicate License Form - New Jersey Division Of Consumer Affairs - Njconsumeraffairs

Completing the Duplicate License Form through the New Jersey Division of Consumer Affairs is an essential step for those needing a replacement for their nursing license due to loss or damage. This guide will walk you through each section of the form to ensure a smooth and accurate submission process.

Follow the steps to accurately complete the Duplicate License Form.

1. Press the ‘Get Form’ button to obtain the duplicate license form and open it in your preferred editing tool.
2. Begin by filling in your name as it appears on your original license. This ensures that the form is correctly identified with your credentials.
3. Enter your license number in the appropriate field. If you do not recall your number, you may need to look it up before proceeding.
4. Provide the address of record. This should be your primary residence where you wish to receive correspondence related to your license.
5. Input your mailing address if it differs from the address of record. If a post office box is used, ensure to include a physical address as well.
6. Fill in your Social Security number. This information helps the Board to correctly verify your identity.
7. Indicate your date of birth to further authenticate your application.
8. List your contact telephone number, including the area code, so the Board can reach you if necessary.
9. Provide your email address for any electronic communication regarding your application.
10. Select the reason for requesting a duplicate license by checking one of the provided options: lost, destroyed, misplaced, stolen, or never received.
11. Check your appropriate license type, indicating whether you are a registered nurse, licensed practical nurse, advanced practical nurse, or certified homemaker-home health aide.
12. Sign the form to certify the accuracy of the information provided. Be aware of the consequences of providing false information.
13. Have the completed affidavit notarized. This step is crucial to validate your request.
14. Prepare your payment. A certified check or money order must be included with your form — $35 for RNs, LPNs, or APNs and $10 for CHHAs.
15. Submit your completed and notarized form along with the payment by sending it to the appropriate address indicated on the form.
16. After submission, you may wish to keep a copy of the completed form for your records.

Complete your duplicate license form online today and ensure your credentials are up to date.