Name of Applicant*

Home Address *

City*

State*

Zip*

DBA / Business Name*

(If a partnership, joint venture, corporation or other type of business association or firm, the name and business address of the organization, and the name and residence of all officers, directors or partners, as the case may be, and their interest in the organization.)

E-mail Address*

Business Address *

City*

State*

Zip*

Telephone/Fax *

Cell Phone *

List all businesses owned, operated and managed by the applicant or in which the applicant has had an interest of any kind during the past five years, and the addresses of these businesses.

1. *

2. *

3. *

4. *

5. *

The above applicant has not been convicted of a felony during the past five (5) years and is not presently indicted for committing a felony.

THREE (3) LETTERS OF RECOMMENDATION MUST ACCOMPANY THIS APPLICATION.
These letters must be from three different reputable businesses or professionals, not related by blood or marriage to the applicant, from the county of the applicant’s home business address, vouching for the applicant’s reputation as to honesty, integrity and good character. The letters must be on company letterhead.

Reference 1*

Convert to PDF?
(DOC, DOCX, XLS, XLSX, TXT)

Reference 2*

Convert to PDF?
(DOC, DOCX, XLS, XLSX, TXT)

Reference 3*

Convert to PDF?
(DOC, DOCX, XLS, XLSX, TXT)

I hereby make application for license/examination for an Electrical/HVAC contractor and hereby certify that the above information is true and correct.

Electrical

HVAC

(The required test is the International Code Council Standard Master Electrician and the Standard Master Mechanical tests. You must show proof of a passing grade of 75% in order to receive reciprocity. Otherwise, you must take the test.)