Application for a Sheltered Workshop Certificate

The Great Seal of the State of New Jersey

NEW JERSEY DEPARTMENT OF LABOR & WORKFORCE DEVELOPMENT

DIVISION OF WAGE AND HOUR COMPLIANCE

Organization/Certificate Information
**
The name of the organization applying for a sheltered workshop certificate
**
(Street)
(Address Line 2)
(City, State, Zip as nnnnn-nnnn or nnnnn)
Street address of location for which certificate is requested

(** indicates a required field)

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