alcohol-application for Licensure

Please check if you are applying for: Attach two, full-face passport- Written Examination style photographs (2 x 2 ) of your Oral Examination head and shoulders, taken within Written and Oral Examinations the past six months. _____. New Jersey Office of the Attorney General Date exam passed Two photographs are required Division of Consumer Affairs with each application. State Board of Marriage and Family Therapy Examiners Certified Alcohol and Alcohol and Drug Counselor Committee Drug Counselor ( ). Do not use staples to attach the 124 Halsey Street, 6th Floor, Box 45040 Licensed Clinical photographs. Newark, New Jersey 07101 Alcohol and Drug (973) 504-6582 Counselor ( ). Licensure by Reciprocity Application for Licensure as a Clinical Alcohol and Drug Counselor or Certification as an Alcohol and Drug Counselor Date: A nonrefundable application filing fee of $75, in the form of a check or money order made out to the State of New Jersey, must be submitted with this application.

Please be aware that you have the right to elect not to answer this question if you have reasonable cause to believe that answering may expose you to the possibility of criminal prosecution. In that event, you may assert the Fifth Amendment privilege against self-incrimination. Any claim of Fifth Amendment privilege must be made in good faith.

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  Atingsa, Self, Rights, Fifth, Amendment, Incrimination, Fifth amendment, Against self

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