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Frequently Asked Questions

New Jersey Office of the Attorney GeneralDivision of Consumer AffairsState Board of Social Work Examiners124 Halsey Street, 6th Floor, Box 45033 Newark, New Jersey 07101(973) 504-6495 Website: Asked Questions What constitutes clinical supervision? A supervised clinical experience could be employment or volunteer, that took place subsequent to earning the degree and prior to being licensed at the clinical level in any state. What if I cannot reach my supervisor from years ago? The following three (3) items must be provided in lieu of the supervision form: 1. A notarized letter from the applicant indicating this fact. 2. Your supervision must be verified by the other state, by releasing your supervision documents directly to the offices of the State Board of Social Work Examiners located at 124 Halsey Street, 6th Fl.

3. Social Security Number You must provide your Social Security number to the Board or Committee. Failure to do so will result in denial/nonrenewal of

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1 New Jersey Office of the Attorney GeneralDivision of Consumer AffairsState Board of Social Work Examiners124 Halsey Street, 6th Floor, Box 45033 Newark, New Jersey 07101(973) 504-6495 Website: Asked Questions What constitutes clinical supervision? A supervised clinical experience could be employment or volunteer, that took place subsequent to earning the degree and prior to being licensed at the clinical level in any state. What if I cannot reach my supervisor from years ago? The following three (3) items must be provided in lieu of the supervision form: 1. A notarized letter from the applicant indicating this fact. 2. Your supervision must be verified by the other state, by releasing your supervision documents directly to the offices of the State Board of Social Work Examiners located at 124 Halsey Street, 6th Fl.

2 , Newark, 07102. 3. Official verification of your supervisor s license must also be provided by the other state. Online verification will not be accepted. What is needed to be sent with the supervision form? If supervision was in New Jersey, your supervisor must provide you with a copy of his/her Certificate of Completion of one of the Board-approved 20-hour supervision courses listed at titled Attention Clinical Supervisors. If supervision was outside of New Jersey, your supervisor must provide his/her curriculum vitae. Who s responsible for having the supervision form notarized? The applicant is responsible. Do I have to list the required 12 semester hours in clinical social work on the application?

3 Yes, courses must be identified by the applicant on the required page of the application, even if a transcript is provided. Does my transcript need to be in a sealed envelope? No, but it has to be an original transcript forwarded directly to the State Board of Social Work Examiners. Would a criminal history background process that I completed for my work be accepted toward this application? No. You would have to go through another criminal history background check for the Division of Consumer Affairs. How would I make sure that I completed the required Association of Social Work Boards ( ) clinical exam? Please contact the at 1 (800) 225-6880. What constitutes an official verification of my social work license?

4 An official letter from the other state(s) is required to verify your social work license. Online verification or the actual license will not be accepted. If I completed the clinical exam in New Jersey, what do I do to verify it? Please provide your examination date on the designated part of the application and/or provide a copy of the un-official passing report. Board staff can then access the official report Office Use OnlyNew Jersey Office of the Attorney GeneralDivision of Consumer AffairsState Board of Social Work Examiners124 Halsey Street, 6th Floor, Box 45033 Newark, New Jersey 07101(973) 504-6495 Website: for Licensure as a Licensed Clinical Social WorkerPursuant to 45:15BB-6 / 13 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 submit-ted with this application.

5 (Applicants should understand that if the application filing fee is paid with a personal check, and the check is returned by the bank due to insufficient funds, the next step in the licensure or certification process will be delayed until the fee is paid.)The Division is precluded by law from disclosing to the public the place of residence of licensees or applicants, without their consent. However, you are required to provide an address that may be released to the public in our directories or in response to other requests (by putting a check in the appropriate box). If you provide your place of residence as your public address of record, we will assume that you have consented to have that address be disclosed. If you do not consent to the disclosure of your place of residence, you should provide an address of record other than your place of residence that may be released to the public.

6 One of your addresses must include a street, city, state and ZIP code. Information that you provide on this application may be subject to public disclosure as required by the Open Public Records Act (OPRA).Please print clearly. You must answer all of the Questions on this Information Date of birth: _____ Month Day Year Name Mrs. _____( _____) Ms. Last name First name Middle initial Maiden name2. Address Home: _____ Street or Box City State ZIP code County _____ _____ Telephone number (include area code) E-mail address Business: _____ Name of company Telephone number (include area code) and extension _____ Street City State ZIP code County Mailing: _____ Street or Box City State ZIP code CountyAttach a clear, full-face passport-style photograph (2 x 2 ) of your head and shoulders, taken within the past six months.

7 A photo is required with each not use a paper clip to attach the Social Security Number You must provide your Social Security number to the Board or Committee. Failure to do so will result in denial/nonrenewal of licensure or certification. *Social Security Number: _____-_____- _____ *Pursuant to 54:50-24 et seq. of the New Jersey taxation law, 2 of the New Jersey Child Support Enforcement Law, Section 1128E(b)(2)A of the Social Security Act and 45 , and , the Board or Committee is required to obtain your Social Security number. Pursuant to these authorities, the Board or Committee is also obligated to provide your Social Security number to: a.

8 The Director of Taxation to assist in the administration and enforcement of any tax law, including for the purpose of reviewing compliance with State tax law and updating and correcting tax records; b. the Probation Division or any other agency responsible for child support enforcement, upon request; and c. the National Practitioner Data Bank and the Data Bank, when reporting adverse actions relating to health care Citizenship / Immigration Status Federal law limits the issuance or renewal of professional or occupational licenses or certificates to citizens or qualified aliens. To comply with this federal law, check the appropriate box below which indicates your citizenship/immigration status.

9 If you are not a citizen, attach a copy of your alien registration card (front and back) or other documentation issued by the office of Citizenship and Immigration Services (USCIS). citizen Alien lawfully admitted for permanent residence in Other immigration status Questions about your immigration status and whether or not it is a qualifying status under federal law should be directed to the USCIS at: Child Support Please certify, under penalty of perjury, the following: a. Do you currently have a child-support obligation? Yes No (1) If Yes, are you in arrears in payment of said obligation? Yes No (2) If Yes, does the arrearage match or exceed the total amount payable for the past six months?

10 Yes No b. Have you failed to provide any court-ordered health insurance coverage during the past six months? Yes No c. Have you failed to respond to a subpoena relating to either a paternity or child-support proceeding? Yes No d. Are you the subject of a child-support-related arrest warrant? Yes No In accordance with 2 , an answer of Yes to any of the Questions a(1) through d will result in a denial of licensure or certification. Furthermore, any false certification of the above may subject you to a penalty, including, but not limited to, immediate revocation or suspension of licensure or certification. _____ _____ _____ Applicant s name (please print) Applicant s signature Date6.


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