License Form I New Jersey Racing Commission Page 3
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Section B
(THOROUGHBRED ONLY)
2. ( ) TRAINER
3. ( ) ASS’T TRAINER
The Laws of the State of New Jersey mandates that all trainers except those who otherwise would be considered an employee of the owner pursuant
to N.J.S.A. 34:15-129 et. seq. Must purchase and maintain Workers Compensation Insurance coverage for their employees, see P.L. 1999, c.378; N.J.S.A.
34:15-129 et.seq.
Have you read and are you familiar with the Rules in New Jersey? ( ) yes ( ) no
How many horses are in your charge? ______________
List below all persons holding any interest in horses in your charge, include your name if you own any interest. (Use additional page, if necessary)
Name
Street
City/State/Zip
Occupation
______________________
IF YOU ACCEPT HORSES FROM ANY OTHER OWNER WHILE YOU ARE RACING IN NEW JERSEY DURING THE TERM OF THIS LICENSE. A COMPLETE LIST THEREOF
MUST BE FILED IMMEDIATELY WITH THE RACING COMMISSION. FAILURE TO DO THIS MAY RESULT IN THE REVOCATION OR SUSPENSION OF YOUR LICENSE.
List three trainers as references:
Name
Street
City
State
Zip
_________________________________
Where and when were you first granted a Trainer’s license?
State _________
year ________________
Where and when were you first granted an Ass’t Trainer’s license?
State __________
year _______________
Are you licensed as a Trainer now? (
) yes (
) no Where? State _________
Are licensed as an Ass’t Trainer now? (
) yes (
) no Where? State __________
Assistant to ________________________________________________________________________________
___________________________________
(Verified by Trainer)
____________________
Section C
(HARNESS ONLY)
2. (
) TRAINER
4. (
) DRIVER
5. (
) DRIVER/TRAINER ___________
The Laws of the State of New Jersey mandates that all trainers except those who otherwise would be considered an employee of the owner pursuant
to N.J.S.A. 34:15 et. seq. Must purchase and maintain Workers Compensation Insurance coverage for their employees, see P.L. 1999, c.378; N.J.S.A.
34:15-1 et.seq.
Have you read and are you familiar with the Rules of Racing in New Jersey? ( ) yes ( ) no
How many horses are in your charge? ______________
List below all persons holding any interest in horses in your charge, include your name if you own any interest. (Use additional page, if necessary)
Name
Street
City/State/Zip
Occupation
______________________
IF YOU ACCEPT HORSES FROM ANY OTHER OWNER WHILE YOU ARE RACING IN NEW JERSEY DURING THE TERM OF THIS LICENSE. A COMPLETE LIST THEREOF
MUST BE FILED IMMEDIATELY WITH THE RACING COMMISSION. FAILURE TO DO THIS MAY RESULT IN THE REVOCATION OR SUSPENSION OF YOUR LICENSE.
List three trainers as references:
Name
Street
City
State
Zip
_________________________________
If this is your initial application for a Trainer’s license, What was your previous occupation?
Where and when were you first granted a Trainer’s license?
State _______
year ___________
How long have you held a Trainer’s license?
years __________
Are you licensed as a Trainer now?
(
) yes (
) no
Where?
state __________
__________
Section D
(THOROUGHBRED ONLY)
6. (
) JOCKEY
7. (
) JOCKEY APPRENTICE
8. ( ) JOCKEY AGENT
____________
If applying for a (JOCKEY LICENSE) please complete the following:
By whom are you employed?
st
1
Call
nd
2
Call
If applying for a (JOCKEY APPRENTICE LICENSE) please complete the following:
Parent or Guardian Name
Address
(Stret)
(City)
(State)
(Zip)
Contract Employer Name
Address
(Street)
(Signature of Contract Employer)
(City)
(State)
(Zip)
Date and place of first winning mount
/
/
Place
If applying for a (JOCKEY AGENT) please complete the following:
Jockey
Employed by
Jockey /Apprentice
Employed by
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