N.J. Admin. Code § 8:43I-4.1

Current through Register Vol. 56, No. 23, December 2, 2024

Section 8:43I-4.1 - Application

(a) Each applicant for certification as an assisted living administrator shall complete and submit an application/affidavit on a form provided by the Department which shall contain:

1. Personal demographic information containing the applicant's name, mailing address, date of birth, social security number, sex, telephone number and either:

i. The name of the applicant's employer if the applicant is employed by a health care facility performing duties as a assisted living administrator or in a related position; or

ii. The name of the applicant's prospective assisted living employer, if any;

2. An attestation under oath that the person has not been convicted of any disqualifying offenses as defined by 8:43I-4.3;

3. The applicant's original and legal signature; and

4. The seal and signature of a notary public or other person authorized by law to administer oaths.

(b) Incomplete applications will not be accepted for processing, and will be returned to the applicant for completion. No criminal history record background checks will be released unless the Department is in receipt of a completed application.

N.J. Admin. Code § 8:43I-4.1