N.J. Admin. Code § 19:41A-6.2

Current through Register Vol. 56, No. 24, December 18, 2024

Section 19:41A-6.2 - Personal History Disclosure Resubmission Form-Casino Key Employee

(a) A Personal History Disclosure Resubmission Form shall be in a format prescribed by the Commission and may require the applicant to provide the following information:

1. Name;

2. Date of birth;

3. Physical description;

4. Current address;

5. Social Security number, which information is voluntarily provided in accordance with section 7 of the Privacy Act, 5 U.S.C. § 552a;

6. Citizenship and, if applicable, resident alien status, including any employment authorization since the date of the submission of initial license application or last Resubmission Form;

7. Telephone number at current place of employment;

8. Employment history since the date of the submission of initial license application or last Resubmission Form;

9. Any denial, suspension, revocation, or disciplinary action of a casino gaming industry license, permit, or certification since the submission of initial license application or last Resubmission Form;

10. Civil and criminal proceedings in any jurisdiction since the submission of initial license application or last Resubmission Form, as follows:

i. Arrests, charges, or offenses committed by the applicant;

ii. Lawsuits to which the applicant was or is a party; and

iii. Any New Jersey State financial liens or judgments filed against the applicant; and

11. All assets and liabilities of the applicant, as indicated on the net worth statement and supporting schedules in a format prescribed by the Commission, including the following:

i. Bank accounts, including any right of ownership in, control over, or interest in any foreign bank account, and safe deposit boxes;

ii. Loans and notes and other receivables;

iii. Securities;

iv. Real estate interests held by the applicant or the applicant's spouse or dependent children;

v. Life insurance;

vi. Pension funds;

vii. Loans, notes, and other payables;

viii. Taxes payable; and

ix. Mortgages or liens on real estate.

(b) In addition to the information in (a) above, a completed Personal History Disclosure Resubmission Form shall include the following:

1. Copies of Federal and New Jersey tax returns and related information;

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

3. A signed, dated, and notarized Release Authorization, which shall direct all courts, probation departments, selective service boards, employers, educational institutions, financial and other institutions, and all governmental agencies to release any and all information pertaining to the applicant as requested by the Commission or the Division.

4. A certification by the Division that the licensee has been fingerprinted in accordance with the rules of the Division;

5. The fee set forth at N.J.A.C. 19:41A-8.1(b); and

6. The documents required for identification by N.J.A.C. 19:41A-1.3.

N.J. Admin. Code § 19:41A-6.2