State of New Jersey

FORMS

NOTE: EFFECTIVE AS OF
MONDAY, DECEMBER 19, 2011

EMPLOYEE CREDENTIAL
Form #	Document Name
1	Personal History Disclosure Form 3 - Casino Employee Registration
2	Casino Employee License Conversion Application
3	Request to Determine Employment or Reapplication Eligibility
4	License Application Request Form
5	Credit Card Authorization
6	Name/Address Form
7	Request for a Copy of Registration Credential
8	DGE Hearing Notice
9	Right to Appeal to CCC
CASINO LICENSE
Form #	Document Name
20	Multi-Jurisdictional Personal History Disclosure Form
21	NJ Supplemental Form to the Multi-Jurisdictional Personal History Disclosure Form - Casino Qualifiers and Casino Key Employee Qualifiers
22	Personal History Disclosure Resubmission Form - Casino Qualifiers
23	Business Entity Disclosure Form - Casino Companies and Casino Holding and Intermediary Companies
24	Institutional Investor Certification
25	Personal History Disclosure Form 1 - Casino Qualifier
ENTERPRISE LICENSE
Form #	Document Name
30	Instructions for Filing an Application for a Casino Service Industry Enterprise License
31	Business Entity Disclosure Form - Casino Service Industry Enterprise
32	Multi-Jurisdictional Personal History Disclosure Form
33	New Jersey Supplemental Form to the Multi-Jurisdictional Personal History Disclosure Form - Casino Service Industry Enterprise Qualifiers
34	Personal History Disclosure Form 2 - Outside Directors of Holding and Intermediary Companies of Casino Service Industry Enterprises
35	Casino Service Industry Enterprise - Qualifier Resubmission Disclosure Form
36	Equal Opportunity and Affirmative Action Obligations of Casino Service Industry Applicants/Licensees
37	Institutional Investor Certification
38	Labor Organization Registration Statement
39	Labor Organization Individual Disclosure Form
40	Vendor Registration Form - Contact the casino you are doing business with for this form.
41	Vendor Registration Supplemental Disclosure Form
42	Non-Supervisory Employee(s) of a Junket Enterprise Registration Form
43	Credit Card Authorization
44	Request for Removal from Prohibited Vendor List
CASINO HOTEL ALCOHOLIC BEVERAGE LICENSE
Form #	Document Name
50	Casino Hotel Alcoholic Beverage License Application
51	Casino Hotel Alcoholic Beverage License Resubmission
52	Instructions for Casino Hotel Alcoholic Beverage License Application
53	Business Entity Disclosure Form - Casino Hotel Alcoholic Beverage Licensee
54	Business Entity Disclosure Form - Holding Company - Casino Hotel Alcoholic Beverage Licensee
55	Qualifier Disclosure Form - Casino Hotel Alcoholic Beverage Licensee
56	Equal Opportunity and Affirmative Action Obligations of Casino Service Industry Applicants/Licensees
57	Casino Hotel Alcoholic Beverage Social Affair Permit Application
58	Casino Hotel Alcoholic Beverage Consumer Alcoholic Beverage Tasting Permit Application
59	Casino Hotel Alcoholic Beverage Special Disposal Permit Application
60	Casino Hotel Alcoholic Beverage Temporary Miscellaneous Contingency Permit Application
61	Casino Hotel Alcoholic Beverage Donation Permit Application
62	Casino Hotel Alcoholic Beverage Merchandising Permit Application
63	Credit Card Authorization
SELF-EXCLUSION
Form #	Document Name
70	Request for Voluntary Exclusion from Casino Gambling
71	Request for Voluntary Exclusion from Casino Gambling - Instructions
72	Request for Removal from Voluntary Self-Exclusion List
73	Request for Removal from Voluntary Self-Exclusion List - Instructions


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