N.J. Admin. Code § 13:69A-5.14

Current through Register Vol. 56, No. 21, November 4, 2024

Section 13:69A-5.14 - Labor Organization Individual Disclosure Form

(a) A Labor Organization Individual Disclosure Form shall be in a format prescribed by the Division and may require the applicant to provide the following information:

1. Name, including maiden name and any aliases or nicknames;

2. Title or position with the labor organization;

3. Date and place of birth;

4. Physical description including photograph taken within the past 12 months and name printed across the front bottom border;

5. Current address and home telephone number and residence history for the past year;

6. Social Security number, or the reason why the applicant does not have that number, which information shall be utilized solely for tax administration as provided under 42 U.S.C. § 405(c)(2)(C)(i) and N.J.S.A. 54:50-25 and for child support enforcement as provided under 42 U.S.C. § 666(a)(13) and N.J.S.A. 2A:17-56.60;

7. Citizenship and, if applicable, information concerning resident alien status;

8. Full name of the labor organization represented;

9. Telephone number at current place of employment;

10. Employment history:

i. All positions held with a labor organization, union or affiliate, whether or not compensated, for the past five years; and

ii. Last three jobs, indicating any gaming-related positions;

11. Licenses or other approvals held or applied for which are required to participate in any lawful gambling operation in this State or any jurisdiction;

12. Civil, criminal and investigatory proceedings in any jurisdiction as follows:

i. Convictions for crimes or disorderly persons offenses; and

ii. Convictions for contempt for refusal to testify or cooperate with any legislative investigatory body or other official investigatory body of New Jersey or the United States where the investigatory body was investigating crimes relating to gaming, official corruption or organized crime activity; and

13. Financial data, including information concerning any financial interests held in a casino hotel, casino, casino simulcasting facility or casino licensee.

(b) In addition to the information in (a) above, a completed Labor Organization Individual Disclosure Form may include the following:

1. The name, address, occupation and phone number of references;

2. A signed, dated and notarized affidavit of truth;

3. A signed, dated and notarized Release Authorization which shall direct all courts, probation departments, selective service boards, employers, educational institutions, banks, financial and other institutions and all governmental agencies, Federal, state and local, both foreign and domestic, to release any and all information pertaining to the officer, agent or principal employee as requested by the Division; and

4. A waiver of liability as to the State and its instrumentalities and agents for any damages resulting to the officer, agent or principal employee from any disclosure or publication of information acquired during the investigation process, in accordance with N.J.S.A. 5:12-80b.

N.J. Admin. Code § 13:69A-5.14

Amended by 50 N.J.R. 601(b), effective 1/16/2018