REQUEST FOR STATEWIDE ELIGIBLE LIST



REQUEST FOR STATEWIDE ELIGIBLE LIST

New Jersey Civil Service Commission

STATEWIDE INITIATIVES & INTERGOVERNMENTAL SERVICES●PO BOX 313, TRENTON, NJ 08625●TELEPHONE (609) 292-9184

INSTRUCTIONS: Complete the Appointing Authority portion of this form to request a copy of the Statewide Eligible List, also known as the Rice Bill List, as established by NJSA 40A:14-180 for law enforcement officers; NJSA 40A:14-9.9 for Firefighters; and NJSA 40A:14-182 for Federal Firefighters. Once completed, please mail this form to the address listed above or fax to (609) 984-1910.

|APPOINTING AUTHORITY USE ONLY |

|Jurisdiction:       |Jurisdiction Code:       |

|Address:       |

|City:       |State:       |Zip Code:       |

|Type of List Requested: |

|Law Enforcement Officer Correctional Officer Municipal Firefighter Federal Firefighter |

|Contact Person:       |

|Contact Telephone #:       |Contact Fax #:       |

|Contact Email:       |

|Comments: |

|      |

|AA Signature: |Date:       |

|AA Name (Please Print):       |

|CIVIL SERVICE COMMISSION USE ONLY |

|SLGO Tracking #: |

|List ID #: |List Date: |

|Comments: |

|Action Completed by: |Date: |

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