Application for Apparel Industry Certificate of Registration

The Great Seal of the State of New Jersey

NEW JERSEY DEPARTMENT OF LABOR & WORKFORCE DEVELOPMENT

DIVISION OF WAGE AND HOUR COMPLIANCE

PO BOX 389

TRENTON, NEW JERSEY 08625-0389

Application Type/OMNIBUS Information
**
Type of payment
Specific name of the company or agency applying for the certificate
(Street)
(Address Line 2)
(City, State, Zip as nnnnn-nnnn or nnnnn)
Mailing address of the OMNIBUS company or agency

(** indicates a required field)

Page 1 of 8