Form Mw-56 - Application For Apparel Industry Certificate Of Registration - 2011
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1
2STATE OF NEW JERSEY
FOR OFFICE USE ONLY:
Department of Labor and Workforce Development
Division of Wage and Hour Compliance
Log #
__________________________
PO Box 389
Check #
_______________________
Trenton, NJ 08625-0389
Check Amount $ _____________________
APPLICATION FOR APPAREL INDUSTRY CERTIFICATE OF REGISTRATION
Chapter 456, P.L. 1987 – The Apparel Registration Act specifies that no manufacturer or contractor shall engage in the apparel industry
unless registered with the Department of Labor and Workforce Development.
Current Certificate No. __________________________
This application must be accompanied by a check or money order
OMNIBUS REGISTRATION (if applicable )*
made payable to the Commissioner of Labor and Workforce
Company Name __________________________________________
Development.
Return completed application and fee to the address listed above.
Company Address ________________________________________
_______________________________________________________
New Application - $300
* Any division, subsidiary corporation, or related company with the
Renewal - $300
same corporate structure engaged in the apparel industry may be
named and included under one omnibus registration.
1.
______________________________________________________________________________________________________________________
Business Name
2.
______________________________________________________________________________________________________________________
)
Corporate Name
(if different than item #1
3.
______________________________________________________________________________________________________________________
Street Address
(where employees will be working)
City
State
ZIP Code
County
4.
______________________________________________________________________________________________________________________
Mailing Address
(if different than item #3)
5.
______________________________________________________________________________________________________________________
Telephone No.
Fax No.
e-mail
6.
___ ___
___ ___ ___ ___ ___ ___ ___
OR
___ ___ ___
___ ___
___ ___ ___ ___
Federal Employer Identification Number (FEIN)
If no FEIN assigned, enter Social Security No. of owner.
7.
Type of Business:
Individual/Sole Proprietor
Partnership
NJ Corporation
Out-of-State Corporation
LLC (Limited Liability Company)
LLP (Limited Liability Partnership)
Other
_________________
If a corporation, complete the following:
Date of Incorporation ___________________
State of Incorporation
____________
Workers’ Compensation Carrier Name: ____________________________________________________________________
8.
Policy Number: ________________________________________
Effective Date: From ____/____/______ To ____/____/______
9.
Check most applicable:
10. Company has been in business since:
Manufacturer
OR
Contractor
Month ___________________Year __________
Garments
Components
Garments
Components
Greatest number of workers in the past 12 months was ___________
Nature of Business – Type of Garment or Components:
During the month of ______________________
______________________________________________________
FOR OFFICE USE ONLY: UI/DI _______
Employer Master _______
Subcontractor Lookup _______
Apparel Screen _______
Violations _______
MW-56 (R-10-11)
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