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EXPLOSIVES PERMIT APPLICATION

BLASTERS USE PERMIT

APPLICANT’S NAME DATE

STREET PO BOX

CITY STATE ZIP

COUNTY PHONE ( )

GRADE & PERMIT FEES – PLEASE SEE REVERSE SIDE FOR ADDITIONAL INFORMATION Â

Grade of * Annual Fee Grade of * Annual Fee Grade of * Annual Fee
Permit Dollars Permit Dollars Permit Dollars

€ S-1 $200.00 ‰ Q-1 $200.00 €A $200.00

€ S-2 $175.00 ‰ Q-2 $175.00 €D $200.00

€ S-3 $150.00 ‰ Q-3 $150.00 €H $100.00

€ S-4 $125.00 ‰ Q-4 $125.00 €P $200.00

€ S-5 $100.00 ‰ Q-5 $100.00 €Q $200.00

€ S-6 $ 75.00 ‰ Q-6 $ 75.00 €U $200.00

I CERTIFY THAT I AM FAMILIAR WITH AND WILL COMPLY WITH THE NEW JERSEY EXPLOSIVES RULES AND REGULATIONS.

APPLICANT’S SIGNATURE

00000000000000FOR OFFICE USE ONLY00000000000000

INITIAL APPLICATION TEST FEE $25.00 PAID { } DEPOSIT DATE / / .

UPGRADE APPLICATION TEST FEE $25.00 PAID { } DEPOSIT DATE / / .

REMAINING LICENSE FEE $ PAID { } DEPOSIT DATE / / .

PERMIT NO / / / . EXPIRATION DATE / / . DATE ISSUED / / .
INITIAL APPLICATION FOR BLASTERS USE PERMIT (REQUIREMENTS)

a) Submit a Testing Fee of $25.00.
b) Attach a resume of experience detailing your use of explosives.
Date and Place of Birth must be stated
Applicant must be 21 years of age
c) Names and addresses of two (2) persons who can attest to the applicant’s experience with
explosives.
d) Names and addresses of two (2) persons who can attest to the applicant’s character.
e) Two (2) completed sets of Fingerprint Cards processed by your local police authority.
f) Two (2) recent photographs (2” x 2”) of applicant.
g) Authorization of Release of Information (must be signed and notarized).
h) Out of state applicants enclose a copy of any permits that you may have.
i) Include any additional information you feel may be helpful.
j) Submit an Explosives Permit Application-Blasters Use Permit.

UPGRADE APPLICATION (PROCEDURES)

a) Submit an Upgrade Testing Fee of $25.00.
b) Submit a resume of experience detailing what you are now doing with explosives.
c) Submit an Explosives Permit Application-Blasters Use Permit.
d) Name of one (1) person who can attest to your experience with explosives.

EXAMINATION: INITIAL AND UPGRADE (PROCEDURES)

Once the testing fee is received along with all required documentation, an examination will be
scheduled. If for some reason the applicant is unable to attend, they must call the office before the
test date.

EXAMINATION RESULTS (PROCEDURES)

An examiner checks the examination. The applicant will be notified by mail if he/she has passed or
failed the examination. Once the applicant has received his/her notification the testing fee will be
applied to the cost of the permit and the remaining fee shall be submitted to this office for the
processing of the permit.

PERMIT (PROCEDURES)

On receipt of the final payment, the permit will be processed and issued.

OFFICE OF SAFETY COMPLIANCE
PO BOX 386
TRENTON, NEW JERSEY 08625-0386
(609) 292-2096
AUTHORIZATION FOR RELEASE OF INFORMATION
TO BE SUBMITTED WITH
INITIAL APPLICATION FOR NEW JERSEY EXPLOSIVE PERMIT

I am aware of the Privacy Act of 1974 and I know that information may not be released without my
authorization with the following exceptions:

Each applicant is requested to voluntarily provide his or her social security number in his or her
permit application to assist the Commissioner in the enforcement of the provisions of N.J.S.A.
21:1A-128 et seq.

Each social security number will be used as an identifier in the Department of Labor and Workforce
Development’s (LWD) computerized recordkeeping system to aid in the processing of permit
applications.

Each social security number collected shall remain confidential to the LWD and will not appear on
the actual permit.

I authorize the
(Local Police Department Name)

(Address) (City) (State) (Zip Code)

Police Department to release information regarding previous contacts with me to the Office of
Safety Compliance of the New Jersey Department of Labor and Workforce Development.

I hereby release the Police Department, including its
officers, members and employees from all liability for damages of whatever kind which may result to
me, my heirs, family or associates because of my compliance with this authorization and request to
release information, or any attempt to comply with it.

If requested, I authorize that this information may be kept on file at the Office of Safety Compliance
of the New Jersey Department of Labor and Workforce Development.

FULL NAME: SIGNATURE:
(Print)

CURRENT ADDRESS:

TELEPHONE NO.: DATE OF BIRTH:

SOCIAL SECURITY NO.:

WITNESS: DATE:

NOTARIZED:
STATE OF NEW JERSEY
DEPARTMENT OF LABOR AND WORKFORCE DEVELOPMENT
OFFICE OF PUBLIC SAFETY COMPLIANCE
PO BOX 386
TRENTON, N.J. 08625-0386 F.P.C.
(609) 292-2096

APPLICANT
LAST FIRST MIDDLE
APPLICANT FOR
OCCUPATION SEX RACE
ADDRESS AGE DATE OF BIRTH
HEIGHT WEIGHT BUILD COMPL. HAIR
EYES GLASSES CITIZEN MARITAL STATUS N.P.D. NO.
NAME NEAREST RELATIVE ADDRESS

RIGHT THUMB INDEX MIDDLE RING LITTLE

LEFT THUMB INDEX MIDDLE RING LITTLE

PRINTS
DATE
TAKEN BY
CLASS TESTED
BY BY SIGNATURE

LEFT HAND NOTATIONS RIGHT HAND

THUMBS

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PLEASE NOTE: The Fingerprint Card needs to be printed out on ledger or index
paper. If you do not have or can not find ledger or index paper at your local
stationary store, please contact us at (609) 292-2096 and we will mail you the
required Fingerprint Cards.