Form 1 (Personal History Disclosure Form 3) "Casino Employee Registration" - New Jersey

What Is Form 1 (Personal History Disclosure Form 3)?

This is a legal form that was released by the New Jersey Department of Law and Public Safety - Office of The Attorney General - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 11, 2020;
  • The latest edition provided by the New Jersey Department of Law and Public Safety - Office of The Attorney General;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form 1 (Personal History Disclosure Form 3) by clicking the link below or browse more documents and templates provided by the New Jersey Department of Law and Public Safety - Office of the Attorney General.

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Download Form 1 (Personal History Disclosure Form 3) "Casino Employee Registration" - New Jersey

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STATE OF NEW JERSEY
Division of Gaming Enforcement
PERSONAL HISTORY DISCLOSURE FORM 3
Casino Employee Registration
STATE OF NEW JERSEY
Division of Gaming Enforcement
PERSONAL HISTORY DISCLOSURE FORM 3
Casino Employee Registration
DIVISION OF GAMING ENFORCEMENT
FINGERPRINTING INFORMATION
• If you are required to obtain a credential from the New Jersey Division of
Gaming Enforcement or Casino Control Commission, you must be
fingerprinted.
• If you live in New Jersey or Out-of-State but live within a 10-mile radius of the
New Jersey borders, you must be fingerprinted by the Division of Gaming
Enforcement or at a NJ IdentoGo site. Please see the Restricted Zip Code list
Restricted Zip Codes
for the 10-mile radius.
• If you live Out-of-State or Out-of-Country, you must submit fingerprint cards.
Fingerprinting must be performed by a police department or a private
company authorized by the local gaming entity.
INSTRUCTIONS FOR FINGERPRINTING NEW JERSEY APPLICANTS or OUT-OF-
STATE APPLICANTS, who live within 10-mile radius of NJ Border
Division of Gaming Enforcement
To be fingerprinted, by the Division’s Identification Unit, which is located in the
Arcade Building, 1325 Boardwalk (Tennessee Ave & the Boardwalk), Atlantic City,
New Jersey, you must make an appointment. Please call (609) 441-3050 Monday
– Friday (8 am to 4 pm) for an appointment. There is no charge for fingerprinting
at the Arcade Building in Atlantic City.
When you arrive for your fingerprinting appointment, you must present proper
identification.
Please refer to Establishing Your Identity and Work Authorization link.
See
ESTABLISHING YOUR IDENTITY AND WORK AUTHORIZATION
IdentoGo
NJDGE 09/11/2020
Page 1 of 24 Pages
Initials: ___________________
Applicants are required to contact IdentoGO to schedule a time and place to have
their fingerprints captured at an IdentoGO site. Web scheduling is available 24
hours per day, seven days per week. Applicants who do not have World Wide
Web access should call IdentoGO at the company’s
toll-free telephone
number, 1-877-503-5981 (Monday through Friday, 8:00 a.m. to 5:00 p.m., and
Saturday, 8:00 a.m. to 12:00 noon). Spanish-speaking operators are available
upon request. You must bring proper identification with your home address to
the appointment, as outlined on IdentoGO’s website.
Appointment, registration and location information will be available on the
IdentoGO’s
website
(https://www.identogo.com/locations/new-jersey),
to
schedule
an appointment using a unique Service Code for each
agency/fingerprint reason.
IdentoGO has assigned a Service Code for each unique combination of agency and
applicant type. The six-character Service Code is used for uniquely identifying the
Agency (ORI), and Reason for Fingerprinting (RFP). The use of the Service Code
ensures that applicants are being printed for the correct purpose and are not
accidentally or incorrectly being processed for a service they don’t need. Below
is a list of DGE licenses/registrations along with the corresponding Service Codes.
Click on the appropriate Service Code, complete the Universal Fingerprint Form
and schedule your appointment.
The fee for this fingerprinting service is $66.05, which includes the $12 vendor fee
and associated state sales tax. The following forms of payment are accepted:
VISA, Master Card, American Express, Discover, prepaid debit cards, or electronic
debit (ACH) from a checking account. Payment will be collected at the IdentoGO
fingerprint site on the day of the scheduled appointment. Appointments must be
cancelled by 5:00 p.m. on the business day prior to your scheduled time (you
must cancel by Saturday at noon for a Monday appointment).
NJDGE 09/11/2020
Page 2 of 24 Pages
Initials: __________________
If you are applying for:
1) Casino Employee Registration (35),
Service Code 2F12GJ
CLICK HERE
2) Applicant Casino Key Employee (11),
CLICK HERE
Service Code 2F12QV
3) Applicant Casino License (Qualifier),
CLICK HERE
Service Code 2F1132
4) Casino Service Industry License,
CLICK HERE
Service Code 2F12X4
Once your fingerprints are taken you will be required to pay for the fingerprinting.
IdentoGo will provide you with a receipt which the applicant will be responsible to
attach to their DGE credential application form as proof you were fingerprinted.
*Please note: The Division of Gaming Enforcement will not be able to complete
the application process without the IdentoGo receipt attached to the application.
Any questions regarding fingerprinting please contact the Division of Gaming
Enforcement’s Identification Unit at (609) 441-3050 Monday – Friday (8 am to 4
pm).
FINGERPRINTING FOR OUT-OF-STATE or OUT-OF-COUNTRY APPLICANTS
See Out-of-State or Out-of-Country instructions on
https://www.njdge.org.
NOTE: If pdf file does not open in your browser, download the PDF file
to your local hard drive and then open the file with Adobe Reader.
NJDGE 09/11/2020
Page 3 of 24 Pages
Initials: __________________
Personal History Disclosure Form 3
INSTRUCTIONS
I.
COMPLETING THIS FORM:
A.
This application form is to be completed by any person who wishes to apply for a casino
employee registration, or by any person who is directed to do so by the Division.
B.
Read each question carefully prior to answering. Answer every question completely. Do
not leave blank spaces. If a question does not apply to you, indicate “Does Not Apply” in
response to that question. If there is nothing to disclose in response to a particular
question, write “None” in response to that question.
C.
All entries on this form, except initials and signatures, must be typed or printed in block
lettering using only dark ink. If the application is not legible, it will not be accepted.
D.
If you need additional space to answer any question(s), use the blank page provided on
page 17 of this form. If you use this additional space, be sure to indicate the number(s)
of the question(s) which you are answering.
II.
ESTABLISHING YOUR IDENTITY AND WORK AUTHORIZATION:
All applicants must come to the Division office listed below and establish their identity and
employment authorization.
New Jersey Division of Gaming Enforcement
Arcade Building
Tennessee Avenue and the Boardwalk
Atlantic City, NJ 08401
To establish your identity and employment authorization, in accordance with N.J.A.C. 13:69A-
7.2a, you must present the original document(s) listed below in A, B or C.
A.
A current and valid U.S. passport OR a Certificate of U.S. Citizenship OR a Certificate of
Naturalization OR a current and valid identification card issued by the USCIS containing a
photograph or fingerprints and identifying information such as name, date of birth, sex,
height, color of eyes, and address.
NJDGE 09/11/2020
Page 4 of 24 Pages
Initials: __________________