Form Mw-56 - Application For Apparel Industry Certificate Of Registration

11. Provide the names, titles and home addresses of owners, partners, managing members (for LCC companies only), or corporate officers. The

names and the titles of the individuals listed here will appear on the apparel certificate of registration. Add additional sheets if necessary.

_________________________________________________________________________________________________________________

First Name

Last Name

Title

_________________________________________________________________________________________________________________

Social Security No.

% of financial ownership in business (if zero, so state)

Telephone No

_________________________________________________________________________________________________________________

Home Address

City

State

ZIP Code

_________________________________________________________________________________________________________________

First Name

Last Name

Title

_________________________________________________________________________________________________________________

Social Security No.

% of financial ownership in business (if zero, so state)

Telephone No.

_________________________________________________________________________________________________________________

Home Address

City

State

ZIP Code

_________________________________________________________________________________________________________________

First Name

Last Name

Title

_________________________________________________________________________________________________________________

Social Security No.

% of financial ownership in business (if zero, so state)

Telephone No.

_________________________________________________________________________________________________________________

Home Address

City

State

ZIP Code

12. List the names and addresses of all manufacturers, contractors, subcontractors, and jobbers located in the United States with whom you currently

contract work in the apparel and/or embroidery industries. Attach additional sheets if necessary.



If none, please check this box

indicating NONE.

_________________________________________________________________________________________________________________

Name

Telephone No.

_________________________________________________________________________________________________________________

Street Address

City

State

ZIP Code

_________________________________________________________________________________________________________________

Name

Telephone No.

_________________________________________________________________________________________________________________

Street Address

City

State

ZIP Code

_________________________________________________________________________________________________________________

Name

Telephone No.

_________________________________________________________________________________________________________________

Street Address

City

State

ZIP Code

APPLICANT STATEMENT

I understand that the apparel registration for which the employer is applying is issued to a manufacturer or contractor as defined in Chapter 458 of the

New Jersey State Labor Law. I understand that Chapter 458 requires that the registrant makes the required records available to a representative of the

Commissioner of Labor and Workforce Development at its’ place of business upon request and that it must cooperate with any investigation to

determine compliance with the provisions of the labor law. Giving false information on this application may violate the labor law and the penal law

and may result in civil and criminal penalties.

In accordance with the New Jersey Child Support Improvement Act, N.J.S.A. 2A:17-56.44d, by signing this application I am hereby certifying that I do

not have a child support obligation or I have such an obligation but the arrearage amount does not equal or exceed the amount of the child support

payable for six months and any court-ordered health coverage has been provided for the past six months. Furthermore, I certify that I have not failed to

respond to a subpoena relating to a paternity or child support proceeding or I am not the subject of a child support related warrant. I understand that

making a false statement may subject my apparel industry registration certificate to immediate revocation or suspension.

An employer is subject to provision of Chapter 458, P.L. 1987 New Jersey Law, including those requiring payment of at least the applicable New

Jersey State minimum wage; timely payment of wages without deductions except those authorized by law, such as social security or income tax;

accurate payroll records showing the number of hours worked daily and weekly, the amount of gross wages, net wages and deductions; and wage

statements with each payment of wages.

I certify that to the best of my knowledge the information given in response to each question is accurate, true, and complete.

________________________________________________________

_____________________________

Signature

Date

________________________________________________________

Print Name and Title

Form Mw-56 - Application For Apparel Industry Certificate Of Registration - 2011 Page 2

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