DBPR CILB 6-B, Application for Certified Building Contractor Who is Qualifying a Business Instructions
This form contains 398 fields organized into 76 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Additional Contact Information (Optional) | ||
| Alternate Phone Number | Text |
Enter an alternate telephone number where you can be reached, including area code and any necessary country code or extension.
|
| Fax Number | Text |
Enter a fax number for additional contact, including area code and any country code if applicable.
|
| Alternate E-Mail Address | Text |
Enter an alternate email address that can be used to contact you.
|
| Affirmation by Written Declaration - Signer Print Name and Date | ||
| Print Name | Text |
Enter the full printed name of the person signing this affirmation.
|
| Date Signed | Date |
Enter the date on which the signer executed and dated this written declaration.
|
| Applicant Personal Information (SSN, Name, Birth Date, Gender) | ||
| Social Security Number | Text |
Enter the applicant's Social Security Number (nine digits).
|
| Last Name | Text |
Enter the applicant's family/last name as it appears on legal documents.
|
| First Name | Text |
Enter the applicant's given/first name.
|
| Middle Name/Initial | Text |
Enter the applicant's middle name or middle initial.
|
| Name Title | Text |
Enter the applicant's professional or courtesy title (for example, Dr., Mr., Ms.), if applicable.
|
| Name Suffix | Text |
Enter the applicant's name suffix (for example, Jr., Sr., III), if applicable.
|
| Birth Month (MM) | Text |
Enter the applicant's birth month as a two-digit number (MM).
|
| Birth Day (DD) | Text |
Enter the applicant's birth day as a two-digit number (DD).
|
| Birth Year (YYYY) | Number |
Enter the applicant's birth year.
|
| Male | Checkbox |
Check this box if the applicant's gender is Male.
|
| Female | Checkbox |
Check this box if the applicant's gender is Female.
|
| Application Type | ||
| Certified License and Qualify a Business | Checkbox |
Check this box if you are applying for a certified building contractor license and will be qualifying a business (use this application when you will be qualifying only one business entity).
|
| Business Already Qualified (Yes/No) | ||
| Business Already Qualified - No | Checkbox |
Check this box if the business is not currently qualified (registered) in the state or jurisdiction referenced on this form.
|
| Business Already Qualified - Yes | Checkbox |
Check this box if the business is already qualified (registered) in the state or jurisdiction referenced on this form.
|
| Business Contact Information | ||
| Business Contact Name | Text |
Enter the full name of the business contact person responsible for communications about this application.
|
| Business Contact E‑Mail Address | Text |
Enter the business contact's primary e-mail address for written correspondence and notifications.
|
| Business Contact Phone Number | Text |
Provide the telephone number where the business contact can be reached during normal business hours.
|
| Business Identification (Name, DBA, FEID) | ||
| Business Name | Text |
Enter the legal name of the business that is being qualified.
|
| Federal Employer ID Number (FEID) | Number |
Enter the business's Federal Employer Identification Number assigned by the IRS.
|
| Doing Business As (D/B/A) | Text |
Enter any trade name or DBA under which the business operates, if different from the legal name; leave blank if none.
|
| Business Location Address | ||
| Street Address (Business Location) | Text |
Enter the business location's street address or P.O. box, including apartment, suite, or unit number if applicable.
|
| City (Business Location) | Text |
Enter the city where the business location is physically located.
|
| State (Business Location) | Text |
Enter the two-letter state or full state name for the business location.
|
| Zip Code (+4 optional) (Business Location) | Text |
Enter the postal ZIP code for the business location and include the +4 extension if available.
|
| Country (Business Location) | Text |
Enter the country where the business location is located.
|
| County (if Florida address) | Text |
If the business location is in Florida, enter the county name; otherwise leave blank. Fill only if 'State (Business Location)' is 'Florida'.
Depends on:
State (Business Location)
|
| Business Ownership - Fifth Owner Row | ||
| Fifth Owner % of Ownership | Number |
Enter the percentage of ownership in the business held by the fifth listed owner.
|
| Fifth Owner Name | Text |
Enter the full legal name of the fifth listed business owner.
|
| Fifth Owner Address | Text |
Enter the full mailing or street address (including city, state, and ZIP) for the fifth listed owner.
|
| Fifth Owner Social Security # / FEID | Text |
Enter the Social Security number or FEID for the fifth listed owner.
|
| Business Ownership - First Owner Row | ||
| First Owner - % of Ownership | Number |
Specify the percentage of ownership held by the first owner; all owners' percentages must total 100.
|
| First Owner - Social Security # / FEID | Text |
Enter the first owner's tax identification: either their Social Security Number (SSN) or the business Federal Employer Identification Number (FEID).
|
| First Owner - Address | Text |
Provide the mailing address for the first owner including street, city, state and ZIP code.
|
| First Owner - Name | Text |
Enter the full legal name of the first listed business owner (e.g., first and last name or business owner name).
|
| Business Ownership - Fourth Owner Row | ||
| Fourth Owner - % of Ownership | Number |
Enter the percentage of business ownership attributable to the fourth owner.
|
| Fourth Owner - Social Security # / FEID | Text |
Provide the fourth owner's Social Security Number (SSN) or FEID used for tax identification.
|
| Fourth Owner - Name | Text |
Enter the full legal name of the fourth business owner as it should appear on official records.
|
| Fourth Owner - Address | Text |
Enter the full mailing address (street, city, state and ZIP) for the fourth owner.
|
| Business Ownership - Second Owner Row | ||
| Second Owner - % of Ownership | Number |
Enter the percentage of ownership held by the second owner; ensure the total percentage for all owners equals 100%.
|
| Second Owner - Social Security # / FEID | Number |
Enter the Social Security number (SSN) or Federal Employer Identification number (FEID) associated with the second owner.
|
| Second Owner - Name | Text |
Enter the full legal name of the second business owner as it should appear on official records.
|
| Second Owner - Address | Text |
Enter the second owner's mailing or business address, including street address, city, state, and ZIP code.
|
| Business Ownership - Seventh Owner Row | ||
| Seventh Owner - % of Ownership | Number |
Enter the percentage of ownership held by the seventh owner.
|
| Seventh Owner - Social Security # / FEID | Text |
Enter the seventh owner’s Social Security Number or Federal Employer Identification Number (FEID) as issued, including hyphens if normally used.
|
| Seventh Owner - Name | Text |
Enter the full legal name of the seventh business owner exactly as it should appear on official records.
|
| Seventh Owner - Address | Text |
Enter the street or mailing address for the seventh owner, including city, state, and ZIP code.
|
| Business Ownership - Sixth Owner Row | ||
| Sixth Owner - % of Ownership | Number |
Enter the percentage of ownership held by the sixth owner; the total percentage for all owners must equal 100.
|
| Sixth Owner - Social Security # / FEID | Text |
Enter the sixth owner's Social Security Number or Federal Employer Identification Number (FEID/EIN) used for tax identification.
|
| Sixth Owner - Name | Text |
Enter the sixth owner's full legal name (first, middle/initial, last) as it should appear on legal and tax records.
|
| Sixth Owner - Address | Text |
Enter the sixth owner's primary mailing address including street, city, state, and ZIP code.
|
| Business Ownership - Third Owner Row | ||
| Third Owner - % of Ownership | Number |
Enter the percentage of ownership held by the third owner; the combined ownership percentages for all owners must total 100%.
|
| Third Owner - Social Security # / FEID | Text |
Enter the Social Security Number or Federal Employer Identification Number (FEID) for the third owner used for tax identification.
|
| Third Owner - Name | Text |
Enter the full legal name of the third business owner as it should appear on official records.
|
| Third Owner - Address | Text |
Enter the mailing or street address for the third business owner, including city, state, and ZIP code.
|
| Business Type Selection | ||
| Sole Proprietor | Checkbox |
Check this box if the business is operated by an individual as a sole proprietorship.
|
| Other (please specify) | Checkbox |
Check this box if the business type is not listed and write the specific business type on the provided line.
|
| LLC | Checkbox |
Check this box if the business is organized as a limited liability company (LLC).
|
| Corporation | Checkbox |
Check this box if the business is organized as a corporation.
|
| Partnership | Checkbox |
Check this box if the business is organized as a partnership.
|
| Other Business Type (please specify) | Text |
Enter the business type when none of the listed options apply, providing a short descriptive name for the entity (for example, 'Nonprofit', 'Joint Venture', etc.). Fill only if 'Other (please specify)' is 'Yes'.
Depends on:
Other (please specify)
|
| Contact Information | ||
| Primary E-Mail Address | Text |
Enter your primary e-mail address where you regularly receive messages so the licensing board can send correspondence and updates.
|
| Primary Phone Number | Text |
Enter your primary daytime phone number, including area code and any necessary punctuation (e.g., (555) 123-4567) so the licensing board can contact you.
|
| Credit Report Shows 660+ Score (Yes/No) | ||
| Credit score 660 or higher — Yes | Checkbox |
Check this box if the submitted credit report shows a credit score of 660 or higher.
|
| Credit score 660 or higher — No | Checkbox |
Check this box if the submitted credit report does not show a credit score of 660 or higher.
|
| Current/Prior License Information - First License Entry | ||
| 1st License Number | Text |
Enter the license or registration number assigned to the first license (include any letters or punctuation exactly as shown).
|
| 1st Name Used | Text |
Enter the full name that was used on the first license or registration (e.g., maiden name or business name if different).
|
| 1st License/Registration Type | Text |
Enter the type or category of the first license or registration (e.g., Contractor, Real Estate, Nursing).
|
| 1st License State | Text |
Enter the U.S. state or jurisdiction that issued the first license or registration (use the two-letter state abbreviation if applicable).
|
| 1st License Date (From) - Month | Date |
Enter the month (MM) when the first license/registration began.
|
| 1st License Date (To) - Month | Date |
Enter the month (MM) when the first license/registration ended or last renewed.
|
| 1st License Date (From) - Year | Date |
Enter the year (YYYY) when the first license/registration began.
|
| 1st License Date (To) - Year | Date |
Enter the year (YYYY) when the first license/registration ended or last renewed.
|
| 1st License Date (From) - Day | Date |
Enter the day (DD) when the first license/registration began.
|
| 1st License Date (To) - Day | Date |
Enter the day (DD) when the first license/registration ended or last renewed.
|
| Current/Prior License Information - Second License Entry | ||
| Second License Number | Text |
Enter the license or registration number assigned to the second license by the issuing authority.
|
| Second Name Used | Text |
Enter the name under which the second license or registration was issued (leave blank or enter your current name if the same).
|
| Second License/Registration Type | Text |
Enter the type or category of the second license or registration (for example, the profession or business license title).
|
| Second License State | Text |
Enter the state or jurisdiction that issued the second license or registration.
|
| Second License Date (From) - Month | Date |
Enter the month when the second license or registration began.
|
| Second License Date (To) - Month | Date |
Enter the month when the second license or registration ended or expires.
|
| Second License Date (From) - Year | Date |
Enter the year when the second license or registration began.
|
| Second License Date (To) - Year | Date |
Enter the year when the second license or registration ended or expires.
|
| Second License Date (From) - Day | Date |
Enter the day when the second license or registration began.
|
| Second License Date (To) - Day | Date |
Enter the day when the second license or registration ended or expires.
|
| Current/Prior License Information - Third License Entry | ||
| 3rd License Number | Text |
Enter the license or registration number exactly as issued for the third entry.
|
| 3rd Name Used | Text |
Enter the name that was used on that license/registration for the third entry (if different from your current name).
|
| 3rd License/Registration Type | Text |
Enter the type or title of the license or registration for the third entry (e.g., Contractor, Real Estate, etc.).
|
| 3rd License State | Text |
Enter the U.S. state or other issuing jurisdiction for the third license/registration entry.
|
| 3rd License Date (From) - Month | Date |
Provide the starting date (From) of the third license/registration — month portion.
|
| 3rd License Date (To) - Month | Date |
Provide the ending date (To) of the third license/registration — month portion.
|
| 3rd License Date (From) - Year | Date |
Provide the starting date (From) of the third license/registration — year portion.
|
| 3rd License Date (To) - Year | Date |
Provide the ending date (To) of the third license/registration — year portion.
|
| 3rd License Date (From) - Day | Date |
Provide the starting date (From) of the third license/registration — day portion.
|
| 3rd License Date (To) - Day | Date |
Provide the ending date (To) of the third license/registration — day portion.
|
| Duties on the Project | ||
| Duties on the Project | Text |
Briefly describe your specific duties and responsibilities performed on this project, including tasks you completed, supervisory roles, and any relevant scope of work. Fill only if 'Upgrade Method (Method of Qualification #6)' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Duties on the Project | Text |
Describe your specific duties and responsibilities performed on the project in clear, complete sentences (e.g., tasks supervised, trade work performed, equipment used, and scope of your role). Fill only if 'Upgrade Method' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Eighth Person Background Questions | ||
| Eighth Person – Authorized Representative Name | Text |
Enter the printed full name of the authorized representative for the eighth person as shown on the application.
|
| Eighth Person – Social Security Number | Text |
Enter the social security number for the eighth person (digits only) associated with this application.
|
| Eighth Person — Question 1: Yes | Checkbox |
Check this box if the eighth person's answer to Question 1 is 'Yes'.
|
| Eighth Person — Question 1: No | Checkbox |
Check this box if the eighth person's answer to Question 1 is 'No'.
|
| Eighth Person — Question 2: No | Checkbox |
Check this box if the eighth person's answer to Question 2 is 'No'.
|
| Eighth Person — Question 2: Yes | Checkbox |
Check this box if the eighth person's answer to Question 2 is 'Yes'.
|
| Eighth Person — Question 3: Yes | Checkbox |
Check this box if the eighth person's answer to Question 3 is 'Yes'.
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| Eighth Person — Question 3: No | Checkbox |
Check this box if the eighth person's answer to Question 3 is 'No'.
|
| Eighth Person — Question 4: No | Checkbox |
Check this box if the eighth person's answer to Question 4 is 'No'.
|
| Eighth Person — Question 4: Yes | Checkbox |
Check this box if the eighth person's answer to Question 4 is 'Yes'.
|
| Employer Contact (Name and Email) | ||
| Email Address | Text |
Enter the employer contact's email address used for correspondence about this project. Fill only if 'Upgrade Method' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Contact Name | Text |
Enter the full name of the employer contact responsible for this project (e.g., first and last name). Fill only if 'Upgrade Method' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Employer Information | ||
| Employer Name and Address | Text |
Enter the employer's full legal name and its mailing/street address including city, state, and ZIP. Fill only if 'Upgrade Method (Method of Qualification #6)' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Contact Email | Text |
Provide the email address for the employer contact person listed on this entry. Fill only if 'Upgrade Method (Method of Qualification #6)' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Contact Name | Text |
Enter the full name (first and last) of the employer contact person for this employment record. Fill only if 'Upgrade Method (Method of Qualification #6)' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Dates Employed | Date |
Provide the employment start and end dates for this position with the employer. Fill only if 'Upgrade Method (Method of Qualification #6)' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Employer Phone Number | Text |
Enter the employer's primary phone number, including area code and any extension if applicable. Fill only if 'Upgrade Method (Method of Qualification #6)' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Qualifying Contractor License Number | Text |
Enter the license number of the qualifying contractor associated with this employer. Fill only if 'Upgrade Method (Method of Qualification #6)' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Name of Qualifying Contractor | Text |
Enter the full name of the qualifying contractor who performed or supervised the work for this employer. Fill only if 'Upgrade Method (Method of Qualification #6)' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Employer Name and Address | ||
| Employer Name and Address | Text |
Enter the employer's full name and mailing address (street, suite if any, city, state and ZIP) as a single text entry. Fill only if 'Upgrade Method' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Employment Dates and Employer Phone | ||
| Dates Employed (mm/yyyy to mm/yyyy) | Text |
Enter the employment start and end months and years for this employer using the format mm/yyyy to mm/yyyy (for example: 01/2018 to 06/2020). Fill only if 'Upgrade Method' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Employer Phone Number | Text |
Enter the employer's telephone number, including area code and any separators as needed (for example: 555-123-4567). Fill only if 'Upgrade Method' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Experience Areas Covered (Check all that apply) | ||
| Column erection | Checkbox |
Check this box if the project included column erection work. Fill only if 'Upgrade Method (Method of Qualification #6)' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Formwork for structural reinforced concrete | Checkbox |
Check this box if the project included formwork for structural reinforced concrete. Fill only if 'Upgrade Method (Method of Qualification #6)' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Elevated slabs | Checkbox |
Check this box if the project included elevated slab work. Fill only if 'Upgrade Method (Method of Qualification #6)' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Foundation/Slabs greater than 20,000 sq. ft. | Checkbox |
Check this box if the project included foundations or slabs greater than 20,000 square feet. Fill only if 'Upgrade Method (Method of Qualification #6)' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Masonry walls | Checkbox |
Check this box if the project included masonry wall work. Fill only if 'Upgrade Method (Method of Qualification #6)' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Steel erection | Checkbox |
Check this box if the project included steel erection work. Fill only if 'Upgrade Method (Method of Qualification #6)' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Experience Areas Covered (Checkboxes) | ||
| Elevated slabs | Checkbox |
Check this box if the project included construction or installation of elevated slabs. Fill only if 'Upgrade Method' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Formwork for structural reinforced concrete | Checkbox |
Check this box if you performed formwork specifically for structural reinforced concrete on the project. Fill only if 'Upgrade Method' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Column erection | Checkbox |
Check this box if the project included erection of columns. Fill only if 'Upgrade Method' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Foundation/Slabs greater than 20,000 sq. ft. | Checkbox |
Check this box if the project involved foundations or slabs larger than 20,000 square feet. Fill only if 'Upgrade Method' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Masonry walls | Checkbox |
Check this box if the project included construction of masonry walls. Fill only if 'Upgrade Method' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Steel erection | Checkbox |
Check this box if the project included steel erection work. Fill only if 'Upgrade Method' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Fifth Person Background Questions | ||
| Fifth Person – Authorized Representative Print Name | Text |
Enter the full printed name of the authorized representative for the fifth person as it should appear on the form.
|
| Fifth Person – Social Security Number | Text |
Enter the fifth person's Social Security Number (SSN) using digits and any required separators exactly as requested on the form.
|
| Fifth Person - Question 1 Yes | Checkbox |
Check this box if the fifth person answers "Yes" to Question 1.
|
| Fifth Person - Question 1 No | Checkbox |
Check this box if the fifth person answers "No" to Question 1.
|
| Fifth Person - Question 2 No | Checkbox |
Check this box if the fifth person answers "No" to Question 2.
|
| Fifth Person - Question 2 Yes | Checkbox |
Check this box if the fifth person answers "Yes" to Question 2.
|
| Fifth Person - Question 3 Yes | Checkbox |
Check this box if the fifth person answers "Yes" to Question 3.
|
| Fifth Person - Question 3 No | Checkbox |
Check this box if the fifth person answers "No" to Question 3.
|
| Fifth Person - Question 4 No | Checkbox |
Check this box if the fifth person answers "No" to Question 4.
|
| Fifth Person - Question 4 Yes | Checkbox |
Check this box if the fifth person answers "Yes" to Question 4.
|
| Financial Responsibility Course Completed (Yes/No) | ||
| Have you completed a financial responsibility course approved by the Construction Industry Licensing Board? — No | Checkbox |
Check this box if you have not completed a financial responsibility course approved by the Construction Industry Licensing Board. Fill only if 'Credit score 660 or higher — No' is 'Yes'.
Depends on:
Credit score 660 or higher — No
|
| Have you completed a financial responsibility course approved by the Construction Industry Licensing Board? — Yes | Checkbox |
Check this box if you have completed a financial responsibility course that is approved by the Construction Industry Licensing Board. Fill only if 'Credit score 660 or higher — No' is 'Yes'.
Depends on:
Credit score 660 or higher — No
|
| Financial Responsibility Course Details | ||
| School Name | Text |
Enter the full name of the school or organization that provided the approved financial responsibility course. Fill only if 'Have you completed a financial responsibility course approved by the Construction Industry Licensing Board? — Yes' is 'Yes'.
Depends on:
Have you completed a financial responsibility course approved by the Construction Industry Licensing Board? — Yes
|
| Course Name | Text |
Enter the official title of the approved financial responsibility course you completed. Fill only if 'Have you completed a financial responsibility course approved by the Construction Industry Licensing Board? — Yes' is 'Yes'.
Depends on:
Have you completed a financial responsibility course approved by the Construction Industry Licensing Board? — Yes
|
| Date(s) Attended | Date |
Enter the date or date range when you attended the approved financial responsibility course. Fill only if 'Have you completed a financial responsibility course approved by the Construction Industry Licensing Board? — Yes' is 'Yes'.
Depends on:
Have you completed a financial responsibility course approved by the Construction Industry Licensing Board? — Yes
|
| School Provider Number | Text |
Enter the provider number or identifier assigned to the school/provider by the licensing board. Fill only if 'Have you completed a financial responsibility course approved by the Construction Industry Licensing Board? — Yes' is 'Yes'.
Depends on:
Have you completed a financial responsibility course approved by the Construction Industry Licensing Board? — Yes
|
| Financial Responsibility Option 1 (Current Financially Responsible Officer) | ||
| Option 1 - Financially Responsible Officer Name and License Number | Text |
Enter the full name and license number of the currently approved Financially Responsible Officer for the business (provide both name and license number in this single text field). Fill only if 'Financial Responsibility Option 1 – The business currently has an approved Financially Responsible Officer' is 'Yes'.
Depends on:
Financial Responsibility Option 1 – The business currently has an approved Financially Responsible Officer
|
| Financial Responsibility Option 1 – The business currently has an approved Financially Responsible Officer | Checkbox |
Check this box when the business already has an approved Financially Responsible Officer (then provide that officer's name and license number on the line provided).
|
| Financial Responsibility Option 2 (Will Appoint Financially Responsible Officer) | ||
| Proposed Financially Responsible Officer Name (CILB‑8 submitter) | Text |
Enter the full name of the proposed Financially Responsible Officer who will be submitting the CILB 8 application on behalf of the business. Fill only if 'Financial Responsibility Option 2 — Business will appoint a Financially Responsible Officer' is 'Yes'.
Depends on:
Financial Responsibility Option 2 — Business will appoint a Financially Responsible Officer
|
| Financial Responsibility Option 2 — Business will appoint a Financially Responsible Officer | Checkbox |
Check this box if the business intends to appoint a Financially Responsible Officer and you will provide the name of the proposed officer who will submit the required CILB 8 application.
|
| Financial Responsibility Option 3 (No Financially Responsible Officer) | ||
| Option 3 - The business will not designate a Financially Responsible Officer | Checkbox |
Check this box when the business will not appoint a Financially Responsible Officer and the primary qualifying agent will assume financial responsibility for the business organization.
|
| First Explanation Entry (Person/Question/State/Application/Explanation) | ||
| First Explanation — Person Number | Text |
Enter the person number (select 1–5) to indicate which person this explanation refers to. Fill only if 'Question 3' is 'Yes' or 'Question 4' is 'Yes' (for the applicable person).
Depends on:
First Person (Applicant) – Question 3: Yes, Second Person — Question 3: Yes, Third Person (Person #3) – Question 3: Yes, Fourth Person Question 3 — Yes, Fifth Person - Question 3 Yes, Sixth Person - Question 3: Yes, Seventh Person - Question 3 (Yes), Eighth Person — Question 3: Yes, Person 9 — Question 3: Yes, Tenth Person - Question 3: Yes, First Person (Applicant) – Question 4: Yes, Second Person — Question 4: Yes, Third Person (Person #3) – Question 4: Yes, Fourth Person Question 4 — Yes, Fifth Person - Question 4 Yes, Sixth Person - Question 4: Yes, Seventh Person - Question 4 (Yes), Eighth Person — Question 4: Yes, Person 9 — Question 4: Yes, Tenth Person - Question 4: Yes
|
| First — Question #1 | Checkbox |
Check this box if this explanation relates to question number 1 for the first explanation entry. Fill only if 'Question 3' is 'Yes' or 'Question 4' is 'Yes' (for the applicable person).
Depends on:
First Person (Applicant) – Question 3: Yes, Second Person — Question 3: Yes, Third Person (Person #3) – Question 3: Yes, Fourth Person Question 3 — Yes, Fifth Person - Question 3 Yes, Sixth Person - Question 3: Yes, Seventh Person - Question 3 (Yes), Eighth Person — Question 3: Yes, Person 9 — Question 3: Yes, Tenth Person - Question 3: Yes, First Person (Applicant) – Question 4: Yes, Second Person — Question 4: Yes, Third Person (Person #3) – Question 4: Yes, Fourth Person Question 4 — Yes, Fifth Person - Question 4 Yes, Sixth Person - Question 4: Yes, Seventh Person - Question 4 (Yes), Eighth Person — Question 4: Yes, Person 9 — Question 4: Yes, Tenth Person - Question 4: Yes
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| First — Question #2 | Checkbox |
Check this box if this explanation relates to question number 2 for the first explanation entry. Fill only if 'Question 3' is 'Yes' or 'Question 4' is 'Yes' (for the applicable person).
Depends on:
First Person (Applicant) – Question 3: Yes, Second Person — Question 3: Yes, Third Person (Person #3) – Question 3: Yes, Fourth Person Question 3 — Yes, Fifth Person - Question 3 Yes, Sixth Person - Question 3: Yes, Seventh Person - Question 3 (Yes), Eighth Person — Question 3: Yes, Person 9 — Question 3: Yes, Tenth Person - Question 3: Yes, First Person (Applicant) – Question 4: Yes, Second Person — Question 4: Yes, Third Person (Person #3) – Question 4: Yes, Fourth Person Question 4 — Yes, Fifth Person - Question 4 Yes, Sixth Person - Question 4: Yes, Seventh Person - Question 4 (Yes), Eighth Person — Question 4: Yes, Person 9 — Question 4: Yes, Tenth Person - Question 4: Yes
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| First — Question #3 | Checkbox |
Check this box if this explanation relates to question number 3 for the first explanation entry. Fill only if 'Question 3' is 'Yes' or 'Question 4' is 'Yes' (for the applicable person).
Depends on:
First Person (Applicant) – Question 3: Yes, Second Person — Question 3: Yes, Third Person (Person #3) – Question 3: Yes, Fourth Person Question 3 — Yes, Fifth Person - Question 3 Yes, Sixth Person - Question 3: Yes, Seventh Person - Question 3 (Yes), Eighth Person — Question 3: Yes, Person 9 — Question 3: Yes, Tenth Person - Question 3: Yes, First Person (Applicant) – Question 4: Yes, Second Person — Question 4: Yes, Third Person (Person #3) – Question 4: Yes, Fourth Person Question 4 — Yes, Fifth Person - Question 4 Yes, Sixth Person - Question 4: Yes, Seventh Person - Question 4 (Yes), Eighth Person — Question 4: Yes, Person 9 — Question 4: Yes, Tenth Person - Question 4: Yes
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| First — Question #4 | Checkbox |
Check this box if this explanation relates to question number 4 for the first explanation entry. Fill only if 'Question 3' is 'Yes' or 'Question 4' is 'Yes' (for the applicable person).
Depends on:
First Person (Applicant) – Question 3: Yes, Second Person — Question 3: Yes, Third Person (Person #3) – Question 3: Yes, Fourth Person Question 3 — Yes, Fifth Person - Question 3 Yes, Sixth Person - Question 3: Yes, Seventh Person - Question 3 (Yes), Eighth Person — Question 3: Yes, Person 9 — Question 3: Yes, Tenth Person - Question 3: Yes, First Person (Applicant) – Question 4: Yes, Second Person — Question 4: Yes, Third Person (Person #3) – Question 4: Yes, Fourth Person Question 4 — Yes, Fifth Person - Question 4 Yes, Sixth Person - Question 4: Yes, Seventh Person - Question 4 (Yes), Eighth Person — Question 4: Yes, Person 9 — Question 4: Yes, Tenth Person - Question 4: Yes
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| First — Person #5 | Checkbox |
Check this box if this explanation relates to person number 5 for the first explanation entry. Fill only if 'Question 3' is 'Yes' or 'Question 4' is 'Yes' (for the applicable person).
Depends on:
First Person (Applicant) – Question 3: Yes, Second Person — Question 3: Yes, Third Person (Person #3) – Question 3: Yes, Fourth Person Question 3 — Yes, Fifth Person - Question 3 Yes, Sixth Person - Question 3: Yes, Seventh Person - Question 3 (Yes), Eighth Person — Question 3: Yes, Person 9 — Question 3: Yes, Tenth Person - Question 3: Yes, First Person (Applicant) – Question 4: Yes, Second Person — Question 4: Yes, Third Person (Person #3) – Question 4: Yes, Fourth Person Question 4 — Yes, Fifth Person - Question 4 Yes, Sixth Person - Question 4: Yes, Seventh Person - Question 4 (Yes), Eighth Person — Question 4: Yes, Person 9 — Question 4: Yes, Tenth Person - Question 4: Yes
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| First — Person #6 | Checkbox |
Check this box if this explanation relates to person number 6 for the first explanation entry. Fill only if 'Question 3' is 'Yes' or 'Question 4' is 'Yes' (for the applicable person).
Depends on:
First Person (Applicant) – Question 3: Yes, Second Person — Question 3: Yes, Third Person (Person #3) – Question 3: Yes, Fourth Person Question 3 — Yes, Fifth Person - Question 3 Yes, Sixth Person - Question 3: Yes, Seventh Person - Question 3 (Yes), Eighth Person — Question 3: Yes, Person 9 — Question 3: Yes, Tenth Person - Question 3: Yes, First Person (Applicant) – Question 4: Yes, Second Person — Question 4: Yes, Third Person (Person #3) – Question 4: Yes, Fourth Person Question 4 — Yes, Fifth Person - Question 4 Yes, Sixth Person - Question 4: Yes, Seventh Person - Question 4 (Yes), Eighth Person — Question 4: Yes, Person 9 — Question 4: Yes, Tenth Person - Question 4: Yes
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| First — Person #7 | Checkbox |
Check this box if this explanation relates to person number 7 for the first explanation entry. Fill only if 'Question 3' is 'Yes' or 'Question 4' is 'Yes' (for the applicable person).
Depends on:
First Person (Applicant) – Question 3: Yes, Second Person — Question 3: Yes, Third Person (Person #3) – Question 3: Yes, Fourth Person Question 3 — Yes, Fifth Person - Question 3 Yes, Sixth Person - Question 3: Yes, Seventh Person - Question 3 (Yes), Eighth Person — Question 3: Yes, Person 9 — Question 3: Yes, Tenth Person - Question 3: Yes, First Person (Applicant) – Question 4: Yes, Second Person — Question 4: Yes, Third Person (Person #3) – Question 4: Yes, Fourth Person Question 4 — Yes, Fifth Person - Question 4 Yes, Sixth Person - Question 4: Yes, Seventh Person - Question 4 (Yes), Eighth Person — Question 4: Yes, Person 9 — Question 4: Yes, Tenth Person - Question 4: Yes
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| First — Person #8 | Checkbox |
Check this box if this explanation relates to person number 8 for the first explanation entry. Fill only if 'Question 3' is 'Yes' or 'Question 4' is 'Yes' (for the applicable person).
Depends on:
First Person (Applicant) – Question 3: Yes, Second Person — Question 3: Yes, Third Person (Person #3) – Question 3: Yes, Fourth Person Question 3 — Yes, Fifth Person - Question 3 Yes, Sixth Person - Question 3: Yes, Seventh Person - Question 3 (Yes), Eighth Person — Question 3: Yes, Person 9 — Question 3: Yes, Tenth Person - Question 3: Yes, First Person (Applicant) – Question 4: Yes, Second Person — Question 4: Yes, Third Person (Person #3) – Question 4: Yes, Fourth Person Question 4 — Yes, Fifth Person - Question 4 Yes, Sixth Person - Question 4: Yes, Seventh Person - Question 4 (Yes), Eighth Person — Question 4: Yes, Person 9 — Question 4: Yes, Tenth Person - Question 4: Yes
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| First Explanation — State/Jurisdiction | Text |
Enter the state or jurisdiction relevant to this explanation (e.g., state name or territory). Fill only if 'Question 3' is 'Yes' or 'Question 4' is 'Yes' (for the applicable person).
Depends on:
First Person (Applicant) – Question 3: Yes, Second Person — Question 3: Yes, Third Person (Person #3) – Question 3: Yes, Fourth Person Question 3 — Yes, Fifth Person - Question 3 Yes, Sixth Person - Question 3: Yes, Seventh Person - Question 3 (Yes), Eighth Person — Question 3: Yes, Person 9 — Question 3: Yes, Tenth Person - Question 3: Yes, First Person (Applicant) – Question 4: Yes, Second Person — Question 4: Yes, Third Person (Person #3) – Question 4: Yes, Fourth Person Question 4 — Yes, Fifth Person - Question 4 Yes, Sixth Person - Question 4: Yes, Seventh Person - Question 4 (Yes), Eighth Person — Question 4: Yes, Person 9 — Question 4: Yes, Tenth Person - Question 4: Yes
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| First Explanation — Application Type / License Number | Text |
Enter the application type or the license number associated with the matter being explained. Fill only if 'Question 3' is 'Yes' or 'Question 4' is 'Yes' (for the applicable person).
Depends on:
First Person (Applicant) – Question 3: Yes, Second Person — Question 3: Yes, Third Person (Person #3) – Question 3: Yes, Fourth Person Question 3 — Yes, Fifth Person - Question 3 Yes, Sixth Person - Question 3: Yes, Seventh Person - Question 3 (Yes), Eighth Person — Question 3: Yes, Person 9 — Question 3: Yes, Tenth Person - Question 3: Yes, First Person (Applicant) – Question 4: Yes, Second Person — Question 4: Yes, Third Person (Person #3) – Question 4: Yes, Fourth Person Question 4 — Yes, Fifth Person - Question 4 Yes, Sixth Person - Question 4: Yes, Seventh Person - Question 4 (Yes), Eighth Person — Question 4: Yes, Person 9 — Question 4: Yes, Tenth Person - Question 4: Yes
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| First Explanation — Detailed Explanation | Text |
Provide a full, detailed explanation of the circumstances, facts, and any dates relevant to the 'Yes' answer referenced above. Fill only if 'Question 3' is 'Yes' or 'Question 4' is 'Yes' (for the applicable person).
Depends on:
First Person (Applicant) – Question 3: Yes, Second Person — Question 3: Yes, Third Person (Person #3) – Question 3: Yes, Fourth Person Question 3 — Yes, Fifth Person - Question 3 Yes, Sixth Person - Question 3: Yes, Seventh Person - Question 3 (Yes), Eighth Person — Question 3: Yes, Person 9 — Question 3: Yes, Tenth Person - Question 3: Yes, First Person (Applicant) – Question 4: Yes, Second Person — Question 4: Yes, Third Person (Person #3) – Question 4: Yes, Fourth Person Question 4 — Yes, Fifth Person - Question 4 Yes, Sixth Person - Question 4: Yes, Seventh Person - Question 4 (Yes), Eighth Person — Question 4: Yes, Person 9 — Question 4: Yes, Tenth Person - Question 4: Yes
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| First Explanation Entry (Top Section) | ||
| First Explanation - Person #1 | Checkbox |
Check this box if this explanation pertains to person number 1. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
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| First Explanation - Person #2 | Checkbox |
Check this box if this explanation pertains to person number 2. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
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| First Explanation - Person #3 | Checkbox |
Check this box if this explanation pertains to person number 3. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
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| First Explanation - Person #4 | Checkbox |
Check this box if this explanation pertains to person number 4. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
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| First Explanation - Person #5 | Checkbox |
Check this box if this explanation pertains to person number 5. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
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| First Explanation - Person #6 | Checkbox |
Check this box if this explanation pertains to person number 6. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
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| First Explanation - Question #1 | Checkbox |
Check this box if this explanation relates to question number 1 on the form. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
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| First Explanation - Question #2 | Checkbox |
Check this box if this explanation relates to question number 2 on the form. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
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| First Explanation - Have all sanctions been satisfied: Yes | Checkbox |
Check this box if all sanctions related to the offense have been satisfied. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
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| First Explanation - Have all sanctions been satisfied: No | Checkbox |
Check this box if all sanctions related to the offense have not been satisfied. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
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| First - Offense | Text |
Enter the name or description of the offense being explained. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
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| First - Penalty / Disposition | Text |
Enter the penalty, disposition or outcome imposed for the offense. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
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| First - Date of offense | Date |
Enter the date when the offense occurred. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
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| First - County | Text |
Enter the name of the county where the offense occurred. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
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| First - State | Text |
Enter the state where the offense occurred. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
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| First - Description / Explanation | Text |
Provide a detailed written explanation or description of the circumstances related to the offense. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
|
| First - Person number (other/specify) | Text |
Enter the person number this explanation relates to if you need to specify a number not covered by the preset checkboxes. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
|
| First Person Background Questions | ||
| First Person — Applicant Print Name | Text |
Enter the full printed name of the first person who is the applicant as shown on legal documents.
|
| First Person (Applicant) – Question 1: Yes | Checkbox |
Check this box if the first person (applicant) answered 'Yes' to Background Question 1.
|
| First Person (Applicant) – Question 1: No | Checkbox |
Check this box if the first person (applicant) answered 'No' to Background Question 1.
|
| First Person (Applicant) – Question 4: Yes | Checkbox |
Check this box if the first person (applicant) answered 'Yes' to Background Question 4.
|
| First Person (Applicant) – Question 4: No | Checkbox |
Check this box if the first person (applicant) answered 'No' to Background Question 4.
|
| First Person (Applicant) – Question 3: No | Checkbox |
Check this box if the first person (applicant) answered 'No' to Background Question 3.
|
| First Person (Applicant) – Question 3: Yes | Checkbox |
Check this box if the first person (applicant) answered 'Yes' to Background Question 3.
|
| First Person (Applicant) – Question 2: Yes | Checkbox |
Check this box if the first person (applicant) answered 'Yes' to Background Question 2.
|
| First Person (Applicant) – Question 2: No | Checkbox |
Check this box if the first person (applicant) answered 'No' to Background Question 2.
|
| First Person — Social Security Number | Text |
Enter the first person's Social Security Number (SSN); include dashes or spaces if the form requires them.
|
| First Qualifier (Name and License Number) | ||
| First Qualifier - Name | Text |
Enter the full name of the first qualifier (person who qualifies the business), e.g., first and last name. Fill only if 'Business Already Qualified - Yes' is 'Yes'.
Depends on:
Business Already Qualified - Yes
|
| First Qualifier - License Number | Text |
Enter the license or registration number under which the first qualifier is qualified for the business. Fill only if 'Business Already Qualified - Yes' is 'Yes'.
Depends on:
Business Already Qualified - Yes
|
| Fourth Person Background Questions | ||
| Fourth Person — Authorized Representative (Print Name) | Text |
Enter the full printed name of the authorized representative for the fourth person as shown on official documents.
|
| Fourth Person — Social Security Number | Text |
Enter the fourth person's Social Security number exactly as assigned (include all digits).
|
| Fourth Person Question 1 — Yes | Checkbox |
Check this box if the fourth person answers 'Yes' to Question 1.
|
| Fourth Person Question 1 — No | Checkbox |
Check this box if the fourth person answers 'No' to Question 1.
|
| Fourth Person Question 2 — No | Checkbox |
Check this box if the fourth person answers 'No' to Question 2.
|
| Fourth Person Question 2 — Yes | Checkbox |
Check this box if the fourth person answers 'Yes' to Question 2.
|
| Fourth Person Question 3 — Yes | Checkbox |
Check this box if the fourth person answers 'Yes' to Question 3.
|
| Fourth Person Question 3 — No | Checkbox |
Check this box if the fourth person answers 'No' to Question 3.
|
| Fourth Person Question 4 — No | Checkbox |
Check this box if the fourth person answers 'No' to Question 4.
|
| Fourth Person Question 4 — Yes | Checkbox |
Check this box if the fourth person answers 'Yes' to Question 4.
|
| Fourth Qualifier (Name and License Number) | ||
| Fourth Qualifier Name | Text |
Enter the full name of the fourth qualifier (the individual whose name is used for the business qualification). Fill only if 'Business Already Qualified - Yes' is 'Yes'.
Depends on:
Business Already Qualified - Yes
|
| Fourth Qualifier License Number | Text |
Enter the license or registration number under which the fourth qualifier is qualified for the business (include any letters or punctuation exactly as shown on the license). Fill only if 'Business Already Qualified - Yes' is 'Yes'.
Depends on:
Business Already Qualified - Yes
|
| Job Title on Project | ||
| Your job title on the project | Text |
Enter the job title or position you held on the listed project (for example: Laborer, Foreman, Project Manager), exactly as it applied during that project. Fill only if 'Upgrade Method (Method of Qualification #6)' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Job Title on the Project | ||
| Job Title on the Project | Text |
Enter the job title or position you held on the project (for example: Carpenter, Site Supervisor, Project Manager). Fill only if 'Upgrade Method' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Mailing Address | ||
| Mailing Street Address or P.O. Box | Text |
Enter the applicant's mailing street address or P.O. Box, including apartment, suite, or unit number if applicable.
|
| Mailing City | Text |
Enter the city for the applicant's mailing address.
|
| Mailing State | Text |
Enter the state or province for the applicant's mailing address (use the standard abbreviation if required).
|
| Mailing ZIP/Postal Code | Text |
Enter the ZIP or postal code for the applicant's mailing address, including the +4 extension if available.
|
| County (if Florida address) | Text |
If the mailing address is in Florida, enter the county name; otherwise leave this field blank. Fill only if 'Mailing State' is 'Florida'.
Depends on:
Mailing State
|
| Country | Text |
Enter the country for the applicant's mailing address.
|
| Street Address or P.O. Box | Text |
Enter the business mailing street address or P.O. Box, including apartment, suite, or unit number if applicable.
|
| City | Text |
Enter the city for the business mailing address.
|
| County (if Florida address) | Text |
If the mailing address is in Florida, enter the county name; otherwise leave this field blank. Fill only if 'State' is 'Florida'.
Depends on:
State
|
| Country | Text |
Enter the country for the mailing address (use the full country name).
|
| State | Text |
Enter the state or province for the mailing address (use the standard two-letter U.S. state abbreviation if applicable).
|
| Zip Code | Text |
Enter the postal ZIP or postal code for the mailing address (include ZIP+4 if available).
|
| Military Veterans Qualification Method Selection | ||
| Three years of military service and one year experience as a foreman | Checkbox |
Check this box if you have three years of military service and at least one year of experience as a foreman applicable to the category for which you are applying.
|
| Two years of military service, one year experience as a foreman, and one year experience as a worker or foreman | Checkbox |
Check this box if you have two years of military service, one year of experience as a foreman, and one additional year of experience as a worker or foreman applicable to the category for which you are applying.
|
| One year of military service, one year experience as a foreman, and two years experience as a worker or foreman | Checkbox |
Check this box if you have one year of military service, one year of experience as a foreman, and two years of experience as a worker or foreman applicable to the category for which you are applying.
|
| Ninth Person Background Questions | ||
| Ninth Person - Authorized Representative Print Name | Text |
Enter the printed full name of the ninth person’s authorized representative exactly as it should appear on the form.
|
| Ninth Person - Social Security Number | Text |
Enter the ninth person’s Social Security Number (SSN) as provided, including dashes if the usual format is used.
|
| Person 9 — Question 1: Yes | Checkbox |
Check this box if the ninth person (Person #9) answers "Yes" to Background Question 1.
|
| Person 9 — Question 1: No | Checkbox |
Check this box if the ninth person (Person #9) answers "No" to Background Question 1.
|
| Person 9 — Question 2: No | Checkbox |
Check this box if the ninth person (Person #9) answers "No" to Background Question 2.
|
| Person 9 — Question 2: Yes | Checkbox |
Check this box if the ninth person (Person #9) answers "Yes" to Background Question 2.
|
| Person 9 — Question 3: Yes | Checkbox |
Check this box if the ninth person (Person #9) answers "Yes" to Background Question 3.
|
| Person 9 — Question 3: No | Checkbox |
Check this box if the ninth person (Person #9) answers "No" to Background Question 3.
|
| Person 9 — Question 4: No | Checkbox |
Check this box if the ninth person (Person #9) answers "No" to Background Question 4.
|
| Person 9 — Question 4: Yes | Checkbox |
Check this box if the ninth person (Person #9) answers "Yes" to Background Question 4.
|
| Part A Qualification Method Selection | ||
| Part A - Four-year construction-related degree plus one year proven experience | Checkbox |
Check this box if you have a four-year construction-related degree from an accredited college (equivalent to three years' experience) and at least one year of proven experience applicable to the category for which you are applying.
|
| Part A - One year foreman experience plus three years college-level credits | Checkbox |
Check this box if you have at least one year of experience as a foreman and not less than three years of credits from accredited college-level courses.
|
| Part A - One year worker, one year foreman, plus two years college-level credits | Checkbox |
Check this box if you have one year experience as a worker, one year experience as a foreman, and two years of credits from accredited college-level courses.
|
| Part A - Two years worker, one year foreman, plus one year college-level credits | Checkbox |
Check this box if you have two years experience as a worker, one year experience as a foreman, and one year of credits from accredited college-level courses.
|
| Part A - Four years experience (at least one year as a foreman) | Checkbox |
Check this box if you have four years of experience as a worker or foreman, of which at least one year was as a foreman.
|
| Part A - "Upgrade Method" (certified residential contractor with 3+ years active license) | Checkbox |
Check this box if you are a certified residential contractor holding an active current license in the applicable classification for a minimum of three years; if checked, provide your license number for verification.
|
| Primary Qualifier (Primary Qualifying Agent) | ||
| Primary Qualifying Agent Name | Text |
Enter the full legal name of the person legally appointed to act as the business's primary qualifying agent who supervises and is responsible for the company's construction work.
|
| License Number (if applicable) | Text |
Enter the contractor or qualifying license number assigned to this primary qualifying agent, or leave blank if the agent does not have a license.
|
| Prior Name Information - First Name Used | ||
| Prior Name 1 - Last Name | Text |
Enter the prior or former last name (maiden name, alias, or other surname) you have used. Fill only if 'Prior Name Used — Yes' is 'Yes'.
Depends on:
Prior Name Used — Yes
|
| Prior Name 1 - First Name | Text |
Enter the prior or former first name you were known by. Fill only if 'Prior Name Used — Yes' is 'Yes'.
Depends on:
Prior Name Used — Yes
|
| Prior Name 1 - Middle Name | Text |
Enter the middle name or middle initial that was used with that prior name. Fill only if 'Prior Name Used — Yes' is 'Yes'.
Depends on:
Prior Name Used — Yes
|
| Prior Name 1 - Title | Text |
Enter any title or honorific used with that name (for example, Mr., Mrs., Dr.). Fill only if 'Prior Name Used — Yes' is 'Yes'.
Depends on:
Prior Name Used — Yes
|
| Prior Name 1 - Suffix | Text |
Enter any suffix used with that name (for example, Jr., Sr., III). Fill only if 'Prior Name Used — Yes' is 'Yes'.
Depends on:
Prior Name Used — Yes
|
| Prior Name Information - Second Name Used | ||
| Second Prior Last Name | Text |
Enter the last (family) name you previously used for this second prior/alternate name. Fill only if 'Prior Name Used — Yes' is 'Yes'.
Depends on:
Prior Name Used — Yes
|
| Second Prior First Name | Text |
Enter the first (given) name you previously used for this second prior/alternate name. Fill only if 'Prior Name Used — Yes' is 'Yes'.
Depends on:
Prior Name Used — Yes
|
| Second Prior Middle Name | Text |
Enter the middle name or initial you previously used for this second prior/alternate name. Fill only if 'Prior Name Used — Yes' is 'Yes'.
Depends on:
Prior Name Used — Yes
|
| Second Prior Title | Text |
Enter any courtesy or professional title you used with this second prior/alternate name (for example, Mr., Ms., Dr.). Fill only if 'Prior Name Used — Yes' is 'Yes'.
Depends on:
Prior Name Used — Yes
|
| Second Prior Suffix | Text |
Enter any suffix that was used with this second prior/alternate name (for example, Jr., Sr., III). Fill only if 'Prior Name Used — Yes' is 'Yes'.
Depends on:
Prior Name Used — Yes
|
| Prior Name Information - Third Name Used | ||
| Third Prior Last Name | Text |
Enter the last/surname you used for the third prior name (maiden, married, alias, or other prior surname). Fill only if 'Prior Name Used — Yes' is 'Yes'.
Depends on:
Prior Name Used — Yes
|
| Third Prior First Name | Text |
Enter the first/given name you used for the third prior name. Fill only if 'Prior Name Used — Yes' is 'Yes'.
Depends on:
Prior Name Used — Yes
|
| Third Prior Middle Name | Text |
Enter the middle name or initial you used with the third prior name, or leave blank if none. Fill only if 'Prior Name Used — Yes' is 'Yes'.
Depends on:
Prior Name Used — Yes
|
| Third Prior Title | Text |
Enter any professional or courtesy title (for example, Dr., Mr., Ms.) that accompanied the third prior name, or leave blank if none. Fill only if 'Prior Name Used — Yes' is 'Yes'.
Depends on:
Prior Name Used — Yes
|
| Third Prior Suffix | Text |
Enter any suffix (for example, Jr., Sr., III) associated with the third prior name, or leave blank if none. Fill only if 'Prior Name Used — Yes' is 'Yes'.
Depends on:
Prior Name Used — Yes
|
| Prior Name Used (Yes/No) | ||
| Prior Name Used — Yes | Checkbox |
Check this box if you have used, been known as, or are currently known by another name (for example: maiden name, pseudonym, nickname, or alias) other than the name on this application.
|
| Prior Name Used — No | Checkbox |
Check this box if you have never used and are not known by any name other than the name signed on this application.
|
| Project Dates | ||
| Dates of Project (mm/yyyy to mm/yyyy) | Text |
Enter the project start and end month/year range for this project using the format mm/yyyy to mm/yyyy (for example, 01/2020 to 12/2020). Fill only if 'Upgrade Method (Method of Qualification #6)' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Project Dates (mm/yyyy to mm/yyyy) | Date |
Enter the project start and end month/year for this project in the format "mm/yyyy to mm/yyyy" (for example, 01/2020 to 12/2020). Fill only if 'Upgrade Method' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Project Name and Address | ||
| Project Name | Text |
Enter the official name or title of the project as it appears on contracts or project documents. Fill only if 'Upgrade Method (Method of Qualification #6)' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Project Address | Text |
Enter the full street address of the project location, including number, street, city, and state as applicable. Fill only if 'Upgrade Method (Method of Qualification #6)' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Project Name | Text |
Enter the official name or title of the project as it appears on plans or contract documents. Fill only if 'Upgrade Method' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Project Address | Text |
Enter the full street address (including city, state, and ZIP) where the project is located. Fill only if 'Upgrade Method' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Project Specifics | ||
| Project Specifics | Text |
Describe the project in detail (for example: number of stories, total square footage, primary materials used, special structural features, and any other relevant specifications). Fill only if 'Upgrade Method (Method of Qualification #6)' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Project Specifics | Text |
Enter detailed specifics about the project such as number of stories, total square footage, construction materials, special features, and any other relevant measurements or notes describing the scope of work. Fill only if 'Upgrade Method' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Project Type | ||
| Project Type | Text |
Enter a short text value indicating the project type for this job (e.g., 'New Construction', 'Renovation', or a short internal code representing the project type). Fill only if 'Upgrade Method (Method of Qualification #6)' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Project Type - New Construction | Checkbox |
Check this box if the project was new construction (a newly built structure). Fill only if 'Upgrade Method (Method of Qualification #6)' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Project Type - Renovation | Checkbox |
Check this box if the project was a renovation, remodel, or alteration of an existing structure. Fill only if 'Upgrade Method (Method of Qualification #6)' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Project Type (Description and Checkboxes) | ||
| Project Type Code | Text |
Enter the project type code or short identifier that indicates the type of project (use the numeric or short code required by this form). Fill only if 'Upgrade Method' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| New Construction | Checkbox |
Check this box when the project is new construction (the work involves building a new structure). Fill only if 'Upgrade Method' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Renovation | Checkbox |
Check this box when the project is a renovation (the work involves remodeling, altering, or repairing an existing structure). Fill only if 'Upgrade Method' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Public Liability and Property Damage Insurance (Yes/No) | ||
| Question 1: Public liability and property damage insurance — Yes | Checkbox |
Check this box if you have obtained public liability and property damage insurance in the amounts required by the Construction Industry Licensing Board as specified above.
|
| Question 1: Public liability and property damage insurance — No | Checkbox |
Check this box if you have not obtained public liability and property damage insurance in the amounts required by the Construction Industry Licensing Board as specified above.
|
| Qualifying Contractor for Employer (Name and License Number) | ||
| Qualifying contractor license number | Text |
Enter the license number issued to the qualifying contractor by the licensing authority. Fill only if 'Upgrade Method' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Qualifying contractor name | Text |
Enter the full name of the qualifying contractor for this employer as shown on records or contracts. Fill only if 'Upgrade Method' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Residence Address (If Different Than Mailing Address) | ||
| Residence Street Address | Text |
Enter the full street address of your residence (include apartment or unit number if applicable). Fill only if 'Mailing Street Address or P.O. Box', 'Mailing City', 'Mailing State', 'Mailing ZIP/Postal Code', 'County (if Florida address)', 'Country' is different (any fields).
Depends on:
Mailing Street Address or P.O. Box, Mailing City, Mailing State, Mailing ZIP/Postal Code, County (if Florida address), Country
|
| Residence City | Text |
Enter the city where your residence is located. Fill only if 'Mailing Street Address or P.O. Box', 'Mailing City', 'Mailing State', 'Mailing ZIP/Postal Code', 'County (if Florida address)', 'Country' is different (any fields).
Depends on:
Mailing Street Address or P.O. Box, Mailing City, Mailing State, Mailing ZIP/Postal Code, County (if Florida address), Country
|
| Residence County (if Florida address) | Text |
If your residence is in Florida, enter the county name for your address. Fill only if 'Residence State' is 'Florida'.
Depends on:
Residence State
|
| Residence Country | Text |
Enter the country of your residence. Fill only if 'Mailing Street Address or P.O. Box', 'Mailing City', 'Mailing State', 'Mailing ZIP/Postal Code', 'County (if Florida address)', 'Country' is different (any fields).
Depends on:
Mailing Street Address or P.O. Box, Mailing City, Mailing State, Mailing ZIP/Postal Code, County (if Florida address), Country
|
| Residence ZIP Code (ZIP+4 optional) | Text |
Enter the 5-digit ZIP Code for your residence; you may include the ZIP+4 extension if available. Fill only if 'Mailing Street Address or P.O. Box', 'Mailing City', 'Mailing State', 'Mailing ZIP/Postal Code', 'County (if Florida address)', 'Country' is different (any fields).
Depends on:
Mailing Street Address or P.O. Box, Mailing City, Mailing State, Mailing ZIP/Postal Code, County (if Florida address), Country
|
| Residence State | Text |
Enter the state of your residence (use the two-letter postal abbreviation if known). Fill only if 'Mailing Street Address or P.O. Box', 'Mailing City', 'Mailing State', 'Mailing ZIP/Postal Code', 'County (if Florida address)', 'Country' is different (any fields).
Depends on:
Mailing Street Address or P.O. Box, Mailing City, Mailing State, Mailing ZIP/Postal Code, County (if Florida address), Country
|
| Role on Project (Worker or Foreman) | ||
| Worker (Role on Project) | Checkbox |
Check this box if, for the project described, your role was as a worker (not as the foreman) — select only one role. Fill only if 'Upgrade Method (Method of Qualification #6)' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Foreman (Role on Project) | Checkbox |
Check this box if, for the project described, your role was as the foreman/supervisor (not as a worker) — select only one role. Fill only if 'Upgrade Method (Method of Qualification #6)' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Role Selection (Worker or Foreman) | ||
| Foreman | Checkbox |
Check this box if, for the employment/project listed, you served as the foreman or supervisor of the work; select only one role. Fill only if 'Upgrade Method' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Worker | Checkbox |
Check this box if, for the employment/project listed, you performed the work in the role of a worker (not as a foreman); select only one role. Fill only if 'Upgrade Method' is 'No'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
|
| Second Explanation Entry (Middle Section) | ||
| Second Explanation Entry - Question 1 | Checkbox |
Check this box if this explanation relates specifically to question #1 on the main form. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
|
| Second Explanation Entry - Question 2 | Checkbox |
Check this box if this explanation relates specifically to question #2 on the main form. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
|
| Second Explanation Entry - Have all sanctions been satisfied? Yes | Checkbox |
Check this box if all sanctions related to this offense have been satisfied. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
|
| Second Explanation Entry - Have all sanctions been satisfied? No | Checkbox |
Check this box if all sanctions related to this offense have not been satisfied. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
|
| Second Explanation - Person 10 | Checkbox |
Check this box if this explanation applies to person #10. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
|
| Second Explanation - Person 9 | Checkbox |
Check this box if this explanation applies to person #9. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
|
| Second Explanation - Person 7 | Checkbox |
Check this box if this explanation applies to person #7. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
|
| Second Explanation Entry - Person 5 | Checkbox |
Check this box if the explanation relates to person #5. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
|
| Second Explanation Entry - Person 3 | Checkbox |
Check this box if the explanation relates to person #3. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
|
| Second Explanation Entry - Person 1 | Checkbox |
Check this box if the explanation relates to person #1. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
|
| Second — Offense | Text |
Enter the name or short description of the offense or charge being explained. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
|
| Second — Penalty/Disposition | Text |
Enter the penalty, disposition, sentence, or outcome imposed for the offense. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
|
| Second — Date of Offense | Date |
Enter the date when the offense occurred. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
|
| Second — County | Text |
Enter the county where the offense occurred. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
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| Second — State | Text |
Enter the state or jurisdiction where the offense occurred. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
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| Second — Description | Text |
Provide a detailed description or explanation of the incident, circumstances, and any other relevant facts. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
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| Second — Person Number | Text |
Enter the person number this explanation relates to (use this field when the person number is not selected from the 1–5 checkboxes). Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
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| Second Explanation Entry (Person/Question/State/Application/Explanation) | ||
| Second explanation — Person number | Text |
Enter the person number that this explanation pertains to (choose 1–5 or enter an alternative number on the blank line). Fill only if 'Question 3' is 'Yes' or 'Question 4' is 'Yes' (for the applicable person).
Depends on:
First Person (Applicant) – Question 3: Yes, Second Person — Question 3: Yes, Third Person (Person #3) – Question 3: Yes, Fourth Person Question 3 — Yes, Fifth Person - Question 3 Yes, Sixth Person - Question 3: Yes, Seventh Person - Question 3 (Yes), Eighth Person — Question 3: Yes, Person 9 — Question 3: Yes, Tenth Person - Question 3: Yes, First Person (Applicant) – Question 4: Yes, Second Person — Question 4: Yes, Third Person (Person #3) – Question 4: Yes, Fourth Person Question 4 — Yes, Fifth Person - Question 4 Yes, Sixth Person - Question 4: Yes, Seventh Person - Question 4 (Yes), Eighth Person — Question 4: Yes, Person 9 — Question 4: Yes, Tenth Person - Question 4: Yes
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| Second Explanation Entry — Question #3 | Checkbox |
Check this box when the explanation you are entering on this (second) explanation entry relates to question number 3 on the form. Fill only if 'Question 3' is 'Yes' or 'Question 4' is 'Yes' (for the applicable person).
Depends on:
First Person (Applicant) – Question 3: Yes, Second Person — Question 3: Yes, Third Person (Person #3) – Question 3: Yes, Fourth Person Question 3 — Yes, Fifth Person - Question 3 Yes, Sixth Person - Question 3: Yes, Seventh Person - Question 3 (Yes), Eighth Person — Question 3: Yes, Person 9 — Question 3: Yes, Tenth Person - Question 3: Yes, First Person (Applicant) – Question 4: Yes, Second Person — Question 4: Yes, Third Person (Person #3) – Question 4: Yes, Fourth Person Question 4 — Yes, Fifth Person - Question 4 Yes, Sixth Person - Question 4: Yes, Seventh Person - Question 4 (Yes), Eighth Person — Question 4: Yes, Person 9 — Question 4: Yes, Tenth Person - Question 4: Yes
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| Second Explanation Entry — Question #2 | Checkbox |
Check this box when the explanation you are entering on this (second) explanation entry relates to question number 2 on the form. Fill only if 'Question 3' is 'Yes' or 'Question 4' is 'Yes' (for the applicable person).
Depends on:
First Person (Applicant) – Question 3: Yes, Second Person — Question 3: Yes, Third Person (Person #3) – Question 3: Yes, Fourth Person Question 3 — Yes, Fifth Person - Question 3 Yes, Sixth Person - Question 3: Yes, Seventh Person - Question 3 (Yes), Eighth Person — Question 3: Yes, Person 9 — Question 3: Yes, Tenth Person - Question 3: Yes, First Person (Applicant) – Question 4: Yes, Second Person — Question 4: Yes, Third Person (Person #3) – Question 4: Yes, Fourth Person Question 4 — Yes, Fifth Person - Question 4 Yes, Sixth Person - Question 4: Yes, Seventh Person - Question 4 (Yes), Eighth Person — Question 4: Yes, Person 9 — Question 4: Yes, Tenth Person - Question 4: Yes
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| Second Explanation Entry — Person #3 | Checkbox |
Check this box when the explanation you are entering on this (second) explanation entry applies to person number 3. Fill only if 'Question 3' is 'Yes' or 'Question 4' is 'Yes' (for the applicable person).
Depends on:
First Person (Applicant) – Question 3: Yes, Second Person — Question 3: Yes, Third Person (Person #3) – Question 3: Yes, Fourth Person Question 3 — Yes, Fifth Person - Question 3 Yes, Sixth Person - Question 3: Yes, Seventh Person - Question 3 (Yes), Eighth Person — Question 3: Yes, Person 9 — Question 3: Yes, Tenth Person - Question 3: Yes, First Person (Applicant) – Question 4: Yes, Second Person — Question 4: Yes, Third Person (Person #3) – Question 4: Yes, Fourth Person Question 4 — Yes, Fifth Person - Question 4 Yes, Sixth Person - Question 4: Yes, Seventh Person - Question 4 (Yes), Eighth Person — Question 4: Yes, Person 9 — Question 4: Yes, Tenth Person - Question 4: Yes
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| Second Explanation Entry — Question #4 | Checkbox |
Check this box when the explanation you are entering on this (second) explanation entry relates to question number 4 on the form. Fill only if 'Question 3' is 'Yes' or 'Question 4' is 'Yes' (for the applicable person).
Depends on:
First Person (Applicant) – Question 3: Yes, Second Person — Question 3: Yes, Third Person (Person #3) – Question 3: Yes, Fourth Person Question 3 — Yes, Fifth Person - Question 3 Yes, Sixth Person - Question 3: Yes, Seventh Person - Question 3 (Yes), Eighth Person — Question 3: Yes, Person 9 — Question 3: Yes, Tenth Person - Question 3: Yes, First Person (Applicant) – Question 4: Yes, Second Person — Question 4: Yes, Third Person (Person #3) – Question 4: Yes, Fourth Person Question 4 — Yes, Fifth Person - Question 4 Yes, Sixth Person - Question 4: Yes, Seventh Person - Question 4 (Yes), Eighth Person — Question 4: Yes, Person 9 — Question 4: Yes, Tenth Person - Question 4: Yes
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| Second Explanation Entry — Person #5 | Checkbox |
Check this box when the explanation you are entering on this (second) explanation entry applies to person number 5. Fill only if 'Question 3' is 'Yes' or 'Question 4' is 'Yes' (for the applicable person).
Depends on:
First Person (Applicant) – Question 3: Yes, Second Person — Question 3: Yes, Third Person (Person #3) – Question 3: Yes, Fourth Person Question 3 — Yes, Fifth Person - Question 3 Yes, Sixth Person - Question 3: Yes, Seventh Person - Question 3 (Yes), Eighth Person — Question 3: Yes, Person 9 — Question 3: Yes, Tenth Person - Question 3: Yes, First Person (Applicant) – Question 4: Yes, Second Person — Question 4: Yes, Third Person (Person #3) – Question 4: Yes, Fourth Person Question 4 — Yes, Fifth Person - Question 4 Yes, Sixth Person - Question 4: Yes, Seventh Person - Question 4 (Yes), Eighth Person — Question 4: Yes, Person 9 — Question 4: Yes, Tenth Person - Question 4: Yes
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| Second Explanation Entry — Person #6 | Checkbox |
Check this box when the explanation you are entering on this (second) explanation entry applies to person number 6. Fill only if 'Question 3' is 'Yes' or 'Question 4' is 'Yes' (for the applicable person).
Depends on:
First Person (Applicant) – Question 3: Yes, Second Person — Question 3: Yes, Third Person (Person #3) – Question 3: Yes, Fourth Person Question 3 — Yes, Fifth Person - Question 3 Yes, Sixth Person - Question 3: Yes, Seventh Person - Question 3 (Yes), Eighth Person — Question 3: Yes, Person 9 — Question 3: Yes, Tenth Person - Question 3: Yes, First Person (Applicant) – Question 4: Yes, Second Person — Question 4: Yes, Third Person (Person #3) – Question 4: Yes, Fourth Person Question 4 — Yes, Fifth Person - Question 4 Yes, Sixth Person - Question 4: Yes, Seventh Person - Question 4 (Yes), Eighth Person — Question 4: Yes, Person 9 — Question 4: Yes, Tenth Person - Question 4: Yes
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| Second Explanation Entry — Person #7 | Checkbox |
Check this box when the explanation you are entering on this (second) explanation entry applies to person number 7. Fill only if 'Question 3' is 'Yes' or 'Question 4' is 'Yes' (for the applicable person).
Depends on:
First Person (Applicant) – Question 3: Yes, Second Person — Question 3: Yes, Third Person (Person #3) – Question 3: Yes, Fourth Person Question 3 — Yes, Fifth Person - Question 3 Yes, Sixth Person - Question 3: Yes, Seventh Person - Question 3 (Yes), Eighth Person — Question 3: Yes, Person 9 — Question 3: Yes, Tenth Person - Question 3: Yes, First Person (Applicant) – Question 4: Yes, Second Person — Question 4: Yes, Third Person (Person #3) – Question 4: Yes, Fourth Person Question 4 — Yes, Fifth Person - Question 4 Yes, Sixth Person - Question 4: Yes, Seventh Person - Question 4 (Yes), Eighth Person — Question 4: Yes, Person 9 — Question 4: Yes, Tenth Person - Question 4: Yes
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| Second Explanation Entry — Person #8 | Checkbox |
Check this box when the explanation you are entering on this (second) explanation entry applies to person number 8. Fill only if 'Question 3' is 'Yes' or 'Question 4' is 'Yes' (for the applicable person).
Depends on:
First Person (Applicant) – Question 3: Yes, Second Person — Question 3: Yes, Third Person (Person #3) – Question 3: Yes, Fourth Person Question 3 — Yes, Fifth Person - Question 3 Yes, Sixth Person - Question 3: Yes, Seventh Person - Question 3 (Yes), Eighth Person — Question 3: Yes, Person 9 — Question 3: Yes, Tenth Person - Question 3: Yes, First Person (Applicant) – Question 4: Yes, Second Person — Question 4: Yes, Third Person (Person #3) – Question 4: Yes, Fourth Person Question 4 — Yes, Fifth Person - Question 4 Yes, Sixth Person - Question 4: Yes, Seventh Person - Question 4 (Yes), Eighth Person — Question 4: Yes, Person 9 — Question 4: Yes, Tenth Person - Question 4: Yes
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| Second explanation — State/Jurisdiction | Text |
Enter the state or jurisdiction relevant to this explanation (use full name or standard postal abbreviation). Fill only if 'Question 3' is 'Yes' or 'Question 4' is 'Yes' (for the applicable person).
Depends on:
First Person (Applicant) – Question 3: Yes, Second Person — Question 3: Yes, Third Person (Person #3) – Question 3: Yes, Fourth Person Question 3 — Yes, Fifth Person - Question 3 Yes, Sixth Person - Question 3: Yes, Seventh Person - Question 3 (Yes), Eighth Person — Question 3: Yes, Person 9 — Question 3: Yes, Tenth Person - Question 3: Yes, First Person (Applicant) – Question 4: Yes, Second Person — Question 4: Yes, Third Person (Person #3) – Question 4: Yes, Fourth Person Question 4 — Yes, Fifth Person - Question 4 Yes, Sixth Person - Question 4: Yes, Seventh Person - Question 4 (Yes), Eighth Person — Question 4: Yes, Person 9 — Question 4: Yes, Tenth Person - Question 4: Yes
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| Second explanation — Application type / License number | Text |
Enter the application type or the license number associated with this explanation exactly as it appears (letters and numbers allowed). Fill only if 'Question 3' is 'Yes' or 'Question 4' is 'Yes' (for the applicable person).
Depends on:
First Person (Applicant) – Question 3: Yes, Second Person — Question 3: Yes, Third Person (Person #3) – Question 3: Yes, Fourth Person Question 3 — Yes, Fifth Person - Question 3 Yes, Sixth Person - Question 3: Yes, Seventh Person - Question 3 (Yes), Eighth Person — Question 3: Yes, Person 9 — Question 3: Yes, Tenth Person - Question 3: Yes, First Person (Applicant) – Question 4: Yes, Second Person — Question 4: Yes, Third Person (Person #3) – Question 4: Yes, Fourth Person Question 4 — Yes, Fifth Person - Question 4 Yes, Sixth Person - Question 4: Yes, Seventh Person - Question 4 (Yes), Eighth Person — Question 4: Yes, Person 9 — Question 4: Yes, Tenth Person - Question 4: Yes
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| Second explanation — Detailed explanation | Text |
Provide the full, detailed explanation for the referenced 'Yes' answer, including dates, circumstances, and any supporting information (attach additional pages if needed). Fill only if 'Question 3' is 'Yes' or 'Question 4' is 'Yes' (for the applicable person).
Depends on:
First Person (Applicant) – Question 3: Yes, Second Person — Question 3: Yes, Third Person (Person #3) – Question 3: Yes, Fourth Person Question 3 — Yes, Fifth Person - Question 3 Yes, Sixth Person - Question 3: Yes, Seventh Person - Question 3 (Yes), Eighth Person — Question 3: Yes, Person 9 — Question 3: Yes, Tenth Person - Question 3: Yes, First Person (Applicant) – Question 4: Yes, Second Person — Question 4: Yes, Third Person (Person #3) – Question 4: Yes, Fourth Person Question 4 — Yes, Fifth Person - Question 4 Yes, Sixth Person - Question 4: Yes, Seventh Person - Question 4 (Yes), Eighth Person — Question 4: Yes, Person 9 — Question 4: Yes, Tenth Person - Question 4: Yes
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| Second Person Background Questions | ||
| Second Person - Authorized Representative (Print Name) | Text |
Enter the full printed name of the authorized representative for the second person.
|
| Second Person — Question 1: Yes | Checkbox |
Check this box if the second person's answer to Background Question 1 is 'Yes'.
|
| Second Person — Question 1: No | Checkbox |
Check this box if the second person's answer to Background Question 1 is 'No'.
|
| Second Person — Question 4: Yes | Checkbox |
Check this box if the second person's answer to Background Question 4 is 'Yes'.
|
| Second Person — Question 4: No | Checkbox |
Check this box if the second person's answer to Background Question 4 is 'No'.
|
| Second Person — Question 3: Yes | Checkbox |
Check this box if the second person's answer to Background Question 3 is 'Yes'.
|
| Second Person — Question 3: No | Checkbox |
Check this box if the second person's answer to Background Question 3 is 'No'.
|
| Second Person — Question 2: Yes | Checkbox |
Check this box if the second person's answer to Background Question 2 is 'Yes'.
|
| Second Person — Question 2: No | Checkbox |
Check this box if the second person's answer to Background Question 2 is 'No'.
|
| Second Person - Social Security Number | Text |
Enter the second person's Social Security Number (include dashes if normally used).
|
| Second Qualifier (Name and License Number) | ||
| Second Qualifier Name | Text |
Enter the full name of the second qualifier (the person authorized to qualify the business) as it should appear on the license. Fill only if 'Business Already Qualified - Yes' is 'Yes'.
Depends on:
Business Already Qualified - Yes
|
| Second Qualifier License Number | Text |
Enter the license or registration number under which the second qualifier is qualified to represent the business, including any letters or dashes if applicable. This field shouldn't be updated during fine-tuning. Fill only if 'Business Already Qualified — Yes' is 'Yes'.
|
| Secondary Qualifier (Optional) | ||
| Secondary Qualifying Agent Name | Text |
Enter the full legal name of the person appointed as the secondary qualifying agent who is responsible for supervising fieldwork at sites where their license was used.
|
| Secondary Qualifier License Number (if applicable) | Text |
Enter the license number of the secondary qualifying agent, if they hold a professional/license number used to obtain the building permit.
|
| Seventh Person Background Questions | ||
| Seventh Person Authorized Representative — Print Name | Text |
Enter the full printed name of the authorized representative for the seventh person as it should appear on official records.
|
| Seventh Person Social Security Number | Text |
Enter the social security number for the seventh person (include all digits as used for identification).
|
| Seventh Person - Question 1 (Yes) | Checkbox |
Check this box if the seventh person (or their authorized representative) answers "Yes" to Question 1 in Section X — Background Questions.
|
| Seventh Person - Question 1 (No) | Checkbox |
Check this box if the seventh person (or their authorized representative) answers "No" to Question 1 in Section X — Background Questions.
|
| Seventh Person - Question 2 (No) | Checkbox |
Check this box if the seventh person (or their authorized representative) answers "No" to Question 2 in Section X — Background Questions.
|
| Seventh Person - Question 2 (Yes) | Checkbox |
Check this box if the seventh person (or their authorized representative) answers "Yes" to Question 2 in Section X — Background Questions.
|
| Seventh Person - Question 3 (Yes) | Checkbox |
Check this box if the seventh person (or their authorized representative) answers "Yes" to Question 3 in Section X — Background Questions.
|
| Seventh Person - Question 3 (No) | Checkbox |
Check this box if the seventh person (or their authorized representative) answers "No" to Question 3 in Section X — Background Questions.
|
| Seventh Person - Question 4 (No) | Checkbox |
Check this box if the seventh person (or their authorized representative) answers "No" to Question 4 in Section X — Background Questions.
|
| Seventh Person - Question 4 (Yes) | Checkbox |
Check this box if the seventh person (or their authorized representative) answers "Yes" to Question 4 in Section X — Background Questions.
|
| Sixth Person Background Questions | ||
| Sixth Person Authorized Representative – Print Name | Text |
Enter the full printed name of the sixth person’s authorized representative.
|
| Sixth Person Social Security Number | Text |
Enter the social security number for the sixth person.
|
| Sixth Person - Question 1: Yes | Checkbox |
Check this box if the sixth person's answer to Question 1 is "Yes."
|
| Sixth Person - Question 1: No | Checkbox |
Check this box if the sixth person's answer to Question 1 is "No."
|
| Sixth Person - Question 2: No | Checkbox |
Check this box if the sixth person's answer to Question 2 is "No."
|
| Sixth Person - Question 2: Yes | Checkbox |
Check this box if the sixth person's answer to Question 2 is "Yes."
|
| Sixth Person - Question 3: Yes | Checkbox |
Check this box if the sixth person's answer to Question 3 is "Yes."
|
| Sixth Person - Question 3: No | Checkbox |
Check this box if the sixth person's answer to Question 3 is "No."
|
| Sixth Person - Question 4: No | Checkbox |
Check this box if the sixth person's answer to Question 4 is "No."
|
| Sixth Person - Question 4: Yes | Checkbox |
Check this box if the sixth person's answer to Question 4 is "Yes."
|
| Tenth Person Background Questions | ||
| Tenth Authorized Representative — Print Name | Text |
Enter the full printed name of the authorized representative for the tenth person.
|
| Tenth Social Security Number | Text |
Enter the tenth person's Social Security number as provided by the individual.
|
| Tenth Person - Question 1: Yes | Checkbox |
Check this box if the tenth person answered "Yes" to Question 1 in Section X (Background Questions).
|
| Tenth Person - Question 1: No | Checkbox |
Check this box if the tenth person answered "No" to Question 1 in Section X (Background Questions).
|
| Tenth Person - Question 2: No | Checkbox |
Check this box if the tenth person answered "No" to Question 2 in Section X (Background Questions).
|
| Tenth Person - Question 2: Yes | Checkbox |
Check this box if the tenth person answered "Yes" to Question 2 in Section X (Background Questions).
|
| Tenth Person - Question 3: Yes | Checkbox |
Check this box if the tenth person answered "Yes" to Question 3 in Section X (Background Questions).
|
| Tenth Person - Question 3: No | Checkbox |
Check this box if the tenth person answered "No" to Question 3 in Section X (Background Questions).
|
| Tenth Person - Question 4: No | Checkbox |
Check this box if the tenth person answered "No" to Question 4 in Section X (Background Questions).
|
| Tenth Person - Question 4: Yes | Checkbox |
Check this box if the tenth person answered "Yes" to Question 4 in Section X (Background Questions).
|
| Third Explanation Entry (Bottom Section) | ||
| Third Explanation - Person #1 | Checkbox |
Check this box if this explanation pertains to person number 1. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
|
| Third Explanation - Person #2 | Checkbox |
Check this box if this explanation pertains to person number 2. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
|
| Third Explanation - Person #3 | Checkbox |
Check this box if this explanation pertains to person number 3. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
|
| Third Explanation - Person #4 | Checkbox |
Check this box if this explanation pertains to person number 4. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
|
| Third Explanation - Person #5 | Checkbox |
Check this box if this explanation pertains to person number 5. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
|
| Third Explanation - Person (Other) | Checkbox |
Check this box if this explanation pertains to a person not listed in options 1–5 (and write the number). Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
|
| Third Explanation - Question #1 | Checkbox |
Check this box if the explanation relates to question number 1. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
|
| Third Explanation - Question #2 | Checkbox |
Check this box if the explanation relates to question number 2. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
|
| Third Explanation - Have all sanctions been satisfied? Yes | Checkbox |
Check this box if all sanctions related to this offense have been satisfied. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
|
| Third Explanation - Have all sanctions been satisfied? No | Checkbox |
Check this box if all sanctions related to this offense have not been satisfied. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
|
| Third - Offense | Text |
Enter the name or short description of the offense, charge, or violation being explained. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
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| Third - Penalty/Disposition | Text |
Enter the penalty, disposition, sentence, or official outcome imposed for the offense. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
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| Third - Date of Offense | Date |
Enter the date on which the offense occurred. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
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| Third - County | Text |
Enter the county where the offense or incident took place. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
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| Third - State | Text |
Enter the state or jurisdiction where the offense or incident occurred. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
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| Third - Description | Text |
Provide a detailed narrative describing the circumstances of the offense and any relevant facts or context. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
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| Third - Person Number (Other) | Text |
If the person referenced is not one of the numbered checkboxes, enter that person's number here. Fill only if 'Background Question #1 or #2' is 'Yes'.
Depends on:
First Person (Applicant) – Question 1: Yes, Second Person — Question 1: Yes, Third Person (Person #3) – Question 1: Yes, Fourth Person Question 1 — Yes, Fifth Person - Question 1 Yes, Sixth Person - Question 1: Yes, Seventh Person - Question 1 (Yes), Eighth Person — Question 1: Yes, Person 9 — Question 1: Yes, Tenth Person - Question 1: Yes, First Person (Applicant) – Question 2: Yes, Second Person — Question 2: Yes, Third Person (Person #3) – Question 2: Yes, Fourth Person Question 2 — Yes, Fifth Person - Question 2 Yes, Sixth Person - Question 2: Yes, Seventh Person - Question 2 (Yes), Eighth Person — Question 2: Yes, Person 9 — Question 2: Yes, Tenth Person - Question 2: Yes
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| Third Person Background Questions | ||
| Third Person — Person 3 Authorized Representative Name | Text |
Enter the printed full name of the authorized representative for person 3 (the Third Person) as shown on the form.
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| Third Person — Person 3 Social Security Number | Text |
Enter the Social Security Number for person 3 (the Third Person) or their authorized representative, using digits (you may include dashes if desired).
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| Third Person (Person #3) – Question 1: Yes | Checkbox |
Check this box if the third person's answer to Question 1 is 'Yes'.
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| Third Person (Person #3) – Question 1: No | Checkbox |
Check this box if the third person's answer to Question 1 is 'No'.
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| Third Person (Person #3) – Question 2: No | Checkbox |
Check this box if the third person's answer to Question 2 is 'No'.
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| Third Person (Person #3) – Question 2: Yes | Checkbox |
Check this box if the third person's answer to Question 2 is 'Yes'.
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| Third Person (Person #3) – Question 3: Yes | Checkbox |
Check this box if the third person's answer to Question 3 is 'Yes'.
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| Third Person (Person #3) – Question 3: No | Checkbox |
Check this box if the third person's answer to Question 3 is 'No'.
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| Third Person (Person #3) – Question 4: No | Checkbox |
Check this box if the third person's answer to Question 4 is 'No'.
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| Third Person (Person #3) – Question 4: Yes | Checkbox |
Check this box if the third person's answer to Question 4 is 'Yes'.
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| Third Qualifier (Name and License Number) | ||
| Third Qualifier Name | Text |
Enter the full name of the third person designated as a qualifier for the business (first and last name and any middle initial as desired). Fill only if 'Business Already Qualified - Yes' is 'Yes'.
Depends on:
Business Already Qualified - Yes
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| Third Qualifier License Number | Text |
Enter the professional or business license number under which the third qualifier is licensed to qualify the business. Fill only if 'Business Already Qualified - Yes' is 'Yes'.
Depends on:
Business Already Qualified - Yes
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| Total Time of Experience from Part B (Worker/Foreman) | ||
| Worker — Total Time | Number |
Enter the total number of years of experience from Part B during which you worked in the Worker role.
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| Foreman — Total Time | Number |
Enter the total number of years of experience from Part B during which you served in the Foreman role.
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| Foreman | Checkbox |
Check this box when entering the total time of experience as a foreman (from your employment history in Part B) that you are claiming toward the qualification.
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| Worker | Checkbox |
Check this box when entering the total time of experience as a worker (from your employment history in Part B) that you are claiming toward the qualification.
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| Upgrade Method License Number | ||
| Upgrade Method License Number | Text |
Enter the active certified residential contractor license number you hold that verifies eligibility under the Upgrade Method. Fill only if 'Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)' is 'Yes'.
Depends on:
Part A - "Upgrade Method" (certified residential contractor with 3+ years active license)
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| Workers' Compensation Insurance or Exemption (Yes/No) | ||
| Workers' Compensation: No | Checkbox |
Check this box if you have not obtained workers' compensation insurance and have not filed for an exemption with the Division of Workers' Compensation.
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| Workers' Compensation: Yes | Checkbox |
Check this box if you have obtained workers' compensation insurance or have filed for an exemption with the Division of Workers' Compensation (or will obtain an exemption within 30 days of license issuance).
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