State of Hawaii Department of Commerce and Consumer Affairs (DCCA) Contractors License Board – Application for Contractor's License (Sole Proprietor) (CT-36) with supporting forms (Experience Certificate CT-03, Contractors Financial Statement CT-02, and Chronological History of Projects/Project List) Instructions
This form contains 514 fields organized into 102 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Affidavit of Applicant - Signature, Print Name, Date | ||
| Affidavit of Applicant - Date | Date |
Provide the date the applicant signed the affidavit.
|
| Affidavit of Applicant - Print Name | Text |
Enter the applicant’s printed full name.
|
| Affidavit of Applicant - Signature | Text |
Enter the applicant's signature as it should appear on the affidavit.
|
| Applicant Addresses | ||
| Mailing Address | Text |
Enter the applicant’s complete mailing address, including street address or P.O. Box, city, state, and ZIP code.
|
| Hawaii Business Address | Text |
Enter the applicant’s Hawaii business street address, including city, state, and ZIP code (P.O. Box is not acceptable).
|
| Residence Address | Text |
Enter the applicant’s current residence address.
|
| Applicant Certification (Signature and Title) | ||
| Applicant Title | Text |
Enter the applicant’s title or role (e.g., owner, president) corresponding to the person who signed the certification.
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| Applicant Signature | Text |
Enter the applicant’s signature certifying that the financial statement information is true and correct.
|
| Applicant Header (Print Name and Date) | ||
| Applicant Printed Name | Text |
Enter the applicant’s full name as printed (last name, first name, and middle name).
|
| Date | Date |
Enter the date the applicant completed or signed this section.
|
| Applicant Identification | ||
| Applicant Printed Name | Text |
Enter the applicant's full name as it should appear in print.
|
| Date | Date |
Enter the date the applicant is completing or signing this form.
|
| Applicant Identification and Contact | ||
| Applicant Name (First, Middle, Last) | Text |
Enter the applicant's full legal name, including first, middle, and last name.
|
| Trade Name or Business Name | Text |
Enter the trade name or business name used by the applicant, if any.
|
| Social Security Number | Text |
Enter the applicant's Social Security number.
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| Daytime Phone Number | Text |
Enter the applicant's daytime phone number.
|
| Email Address | Text |
Enter the applicant's email address.
|
| Applicant Level Worked At | ||
| Level Worked At - Journeyman | Checkbox |
Check this box if the applicant worked at the journeyman level during the period being certified.
|
| Level Worked At - Foreman | Checkbox |
Check this box if the applicant worked at the foreman level during the period being certified.
|
| Level Worked At - Supervisor | Checkbox |
Check this box if the applicant worked at the supervisor level during the period being certified.
|
| Level Worked At - Contractor | Checkbox |
Check this box if the applicant worked at the contractor level during the period being certified.
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| Level Worked At - Other (specify) | Checkbox |
Check this box if the applicant worked at a level other than those listed, and enter the level in the space provided.
|
| Applicant Level Worked At - Other (Specify) Line 1 | Text |
Enter the applicant’s work level if it is not one of the listed options (Journeyman, Foreman, Supervisor, or Contractor). Fill only if 'Level Worked At - Other (specify)' is 'Yes'.
Depends on:
Level Worked At - Other (specify)
|
| Applicant Level Worked At - Other (Specify) Line 2 | Text |
Provide any additional details or continuation of the applicant’s work level description if needed.
|
| Applicant Name | ||
| Applicant Name | Text |
Enter the applicant’s full name as it should be printed (last name, first name, middle name).
|
| Applicant Name | Text |
Enter the applicant’s full legal name (first, middle, last).
|
| Applicant Name | Text |
Enter the applicant's full name (first, middle, and last).
|
| Applicant Name | Text |
Enter the applicant’s full legal name (first, middle, last).
|
| Applicant Name | Text |
Enter the full legal name of the applicant exactly as it appears on the related application.
|
| Applicant Name and Date | ||
| Applicant Name | Text |
Enter the applicant’s full name as it should be printed (last, first, middle).
|
| Date | Date |
Enter the date the applicant completed or signed this form.
|
| Applicant Printed Name | Text |
Enter the applicant's full name as it should be printed on the form.
|
| Applicant Date | Date |
Enter the date associated with the applicant's printed name and certification on this form.
|
| Applicant Name | Text |
Enter the full printed name of the applicant.
|
| Date | Date |
Enter the date associated with the applicant’s signature or form completion.
|
| Applicant Work Level | ||
| Applicant Work Level - Journeyman | Checkbox |
Check this box if the applicant worked at the journeyman level during the period being certified.
|
| Applicant Work Level - Foreman | Checkbox |
Check this box if the applicant worked at the foreman level during the period being certified.
|
| Applicant Work Level - Supervisor | Checkbox |
Check this box if the applicant worked at the supervisor level during the period being certified.
|
| Applicant Work Level - Contractor | Checkbox |
Check this box if the applicant worked as a contractor during the period being certified.
|
| Applicant Work Level - Other | Checkbox |
Check this box if the applicant worked at a different level than those listed and provide the level in the 'Other (specify)' line.
|
| Other Work Level (Specify) - Line 1 | Text |
Enter the specific work level the applicant worked at if it is not listed (e.g., a different title or level). Fill only if 'Applicant Work Level - Other' is 'Yes'.
Depends on:
Applicant Work Level - Other
|
| Other Work Level (Specify) - Line 2 | Text |
Provide any additional details needed to fully specify the applicant’s work level if it does not fit on the first line.
|
| Applicant Work Level (Journeyman/Foreman/Supervisor/Contractor/Other) | ||
| Applicant Work Level - Journeyman | Checkbox |
Check this box if the applicant worked at the journeyman level.
|
| Applicant Work Level - Foreman | Checkbox |
Check this box if the applicant worked at the foreman level.
|
| Applicant Work Level - Supervisor | Checkbox |
Check this box if the applicant worked at the supervisor level.
|
| Applicant Work Level - Contractor | Checkbox |
Check this box if the applicant worked at the contractor level.
|
| Applicant Work Level - Other (specify) | Checkbox |
Check this box if the applicant worked at a level not listed, and specify the level in the provided line.
|
| Other Work Level (Specify) | Text |
Enter the applicant's work level if it is not Journeyman, Foreman, Supervisor, or Contractor. Fill only if 'Applicant Work Level - Other (specify)' is 'Yes'.
Depends on:
Applicant Work Level - Other (specify)
|
| Other Work Level (Additional Details) | Text |
Provide any additional details or continuation of the applicant's specified work level if needed. Fill only if 'Applicant Work Level - Other (specify)' is 'Yes'.
Depends on:
Applicant Work Level - Other (specify)
|
| Application Date | ||
| Application Date | Date |
Enter the date the application is being completed or submitted.
|
| Board Use Only License Number | ||
| Board Use Only License Number | Text |
Enter the contractor license number assigned by the board for this application.
|
| Certifier Business Relationship and Credentials | ||
| Employer | Checkbox |
Check this box if your business relationship to the applicant is as their employer.
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| Supervisor | Checkbox |
Check this box if your business relationship to the applicant is as their supervisor.
|
| RME (Responsible Managing Employee) – provide license number | Checkbox |
Check this box if you are the RME certifying the applicant’s experience and enter your RME license number.
|
| Fellow Employee | Checkbox |
Check this box if your business relationship to the applicant is as a fellow employee (coworker).
|
| Journeyman | Checkbox |
Check this box if your business relationship to the applicant is as a journeyman.
|
| Other (specify) | Checkbox |
Check this box if none of the listed relationships apply and write your relationship in the space provided.
|
| RME License Number | Text |
Enter the Responsible Managing Employee (RME) license number of the person certifying the applicant's experience.
|
| Classifications Held | Text |
List the contractor license classification(s) held by the person certifying the applicant's experience.
|
| Other Business Relationship (Specify) - Line 2 | Text |
Provide any additional business relationship details if needed (second line).
|
| Other Business Relationship (Specify) - Line 1 | Text |
If you selected "Other" for your business relationship to the applicant, specify the relationship details (first line). Fill only if 'Other (specify)' is 'Yes'.
Depends on:
Other (specify)
|
| Certifier Business Relationship to Applicant | ||
| Employer | Checkbox |
Check this box if you are (or were) the applicant’s employer during the period of experience being certified.
|
| Supervisor | Checkbox |
Check this box if you directly supervised the applicant’s work during the period of experience being certified.
|
| RME (Lic. #) | Checkbox |
Check this box if you are certifying as the RME and will provide your RME license number.
|
| Fellow Employee | Checkbox |
Check this box if you worked with the applicant as a co-worker (not as their supervisor or employer) during the period being certified.
|
| Journeyman | Checkbox |
Check this box if your relationship to the applicant is as a journeyman (e.g., you worked with or oversaw work as a journeyman) during the period being certified.
|
| Other (specify) | Checkbox |
Check this box if none of the listed relationships apply and write your business relationship to the applicant in the space provided.
|
| RME License Number | Text |
Enter the Responsible Managing Employee (RME) license number, if applicable to your relationship to the applicant.
|
| Certifier Classifications Held | Text |
List the contractor license classification(s) currently held by the certifier.
|
| Other Business Relationship Details | Text |
Provide any additional details needed to fully describe the certifier’s business relationship to the applicant. Fill only if 'Other (specify)' is 'Yes'.
Depends on:
Other (specify)
|
| Other Business Relationship (Specify) | Text |
Specify the certifier’s business relationship to the applicant if it is not one of the listed options. Fill only if 'Other (specify)' is 'Yes'.
Depends on:
Other (specify)
|
| Employer | Checkbox |
Check this box if your business relationship to the applicant is/was the applicant’s employer.
|
| Supervisor | Checkbox |
Check this box if your business relationship to the applicant is/was as the applicant’s supervisor.
|
| RME (enter license number) | Checkbox |
Check this box if you are the applicant’s RME and provide your RME license number on the line.
|
| Fellow Employee | Checkbox |
Check this box if your business relationship to the applicant is/was as a fellow employee/coworker.
|
| Journeyman | Checkbox |
Check this box if your business relationship to the applicant is/was as a journeyman (working with or over the applicant).
|
| Other (specify) | Checkbox |
Check this box if none of the listed relationships apply and specify your relationship on the line provided.
|
| Certifier Business Relationship - RME License Number | Text |
Enter the Responsible Managing Employee (RME) license number of the person certifying the applicant's experience, if applicable.
|
| Certifier Business Relationship - Classifications Held | Text |
List the contractor license classification(s) held by the person certifying the applicant's experience.
|
| Certifier Business Relationship - Other Relationship Details | Text |
Provide additional details describing the certifier’s business relationship to the applicant when using the “Other (specify)” option.
|
| Certifier Business Relationship - Other Relationship (Specify) | Text |
Specify the certifier’s business relationship to the applicant if it is not one of the listed options. Fill only if 'Other (specify)' is 'Yes'.
Depends on:
Other (specify)
|
| Certifier Certification (Name, Signature, Date) | ||
| Certifier Signature Date | Date |
Enter the date on which the certifier signed this certification.
|
| Certifier Print Name | Text |
Enter the full printed name of the certifier completing this certification.
|
| Certifier Signature | Text |
Provide the certifier’s signature as it will appear in front of a Notary Public.
|
| Certifier Signature Date | Date |
Enter the date the certifier signs this certification.
|
| Certifier Print Name | Text |
Enter the certifier's full printed name.
|
| Certifier Signature | Text |
Enter the certifier's signature as it will appear in front of the notary public.
|
| Certifier Certification Date | Date |
Enter the date the certifier signed the certification.
|
| Certifier Print Name | Text |
Enter the certifier's printed name.
|
| Certifier Signature | Text |
Provide the certifier's signature as it should appear in front of the notary public.
|
| Certifier Contact and License Details | ||
| Certifier Printed Name | Text |
Enter the full printed name of the certifier.
|
| Certifier Address | Text |
Enter the certifier’s mailing address.
|
| Certifier Contractor License No. (ENTITY) | Text |
Enter the certifier’s contractor license number for the ENTITY license.
|
| Certifier Contractor License No. (RME) | Text |
Enter the certifier’s contractor license number for the RME license.
|
| Certifier Licensed Classifications | Text |
Enter the certifier’s licensed contractor classifications.
|
| Certifier State | Text |
Enter the state in which the certifier’s license is issued.
|
| Certifier Home Phone Number | Text |
Enter the certifier’s home phone number.
|
| Certifier Business Phone Number | Text |
Enter the certifier’s business phone number.
|
| Certifier Contact and License Information | ||
| Certifier Printed Name | Text |
Enter the certifier’s full name as it should be printed.
|
| Certifier Address | Text |
Enter the certifier’s mailing address.
|
| Certifier Contractor License No. (ENTITY) | Text |
Enter the certifier’s contractor license number for the ENTITY classification, if applicable.
|
| Certifier Contractor License No. (RME) | Text |
Enter the certifier’s contractor license number for the RME classification, if applicable.
|
| Certifier Licensed Classifications | Text |
Enter the contractor license classifications held by the certifier.
|
| Certifier State | Text |
Enter the state where the certifier is licensed.
|
| Certifier Home Phone Number | Text |
Enter the certifier’s home phone number.
|
| Certifier Business Phone Number | Text |
Enter the certifier’s business phone number.
|
| Certifier Details (Contact and License Info) | ||
| Certifier Printed Name | Text |
Enter the certifier's full name as it should appear in print.
|
| Certifier Address | Text |
Enter the certifier's mailing address.
|
| Contractor License Number (Entity) | Text |
Enter the contractor license number for the entity.
|
| Contractor License Number (RME) | Text |
Enter the contractor license number for the Responsible Managing Employee (RME).
|
| Licensed Classifications of Certifier | Text |
Enter the certifier's licensed contractor classification(s).
|
| Certifier State | Text |
Enter the state associated with the certifier's license information.
|
| Certifier Home Phone Number | Text |
Enter the certifier's home phone number.
|
| Certifier Business Phone Number | Text |
Enter the certifier's business phone number.
|
| Chronological Project History - First Project Row | ||
| First Project Start Date | Date |
Enter the start date of the first listed project.
|
| First Project End Date | Date |
Enter the end date of the first listed project.
|
| First Project Name | Text |
Enter the name or identifying title of the first project.
|
| First Project Employer | Text |
Enter the name of the employer associated with the first project.
|
| First Project Employer Classification | Text |
Enter the employer's classification for the first project.
|
| First Project Position Title and Workers Supervised | Text |
Enter your position title for the first project and the number of workers you supervised.
|
| First Project Detailed Description | Text |
Provide a detailed description of the first project and the work you supervised.
|
| First Project Contract Amount | Number |
Enter the contract amount for the first project.
|
| First Project Supervisory Experience (Years/Months) | Text |
Enter the amount of supervisory experience gained on the first project in years and months.
|
| Chronological Project History - Second Project Row | ||
| Second Project Start Date | Date |
Enter the start date of the second listed project.
|
| Second Project End Date | Date |
Enter the completion/end date of the second listed project.
|
| Second Project Name | Text |
Enter the name or title of the second listed project.
|
| Second Project Employer | Text |
Enter the name of the employer associated with the second listed project.
|
| Second Project Employer Classification | Text |
Enter the employer's classification for the second listed project.
|
| Second Project Position Title and Workers Supervised | Text |
Enter your position title for the second listed project and the number of workers you supervised.
|
| Second Project Detailed Description | Text |
Provide a detailed description of the second listed project and the work you supervised.
|
| Second Project Contract Amount | Number |
Enter the contract amount for the second listed project.
|
| Second Project Supervisory Experience (Years/Months) | Text |
Enter the amount of supervisory experience gained on the second listed project in years and months.
|
| Chronological Project History - Third Project Row | ||
| Third Project Start Date | Date |
Enter the date the third project began.
|
| Third Project End Date | Date |
Enter the date the third project was completed.
|
| Third Project Name | Text |
Enter the name or identifying title of the third project.
|
| Third Project Employer | Text |
Enter the name of the employer you worked for on the third project.
|
| Third Project Employer Classification | Text |
Enter the employer’s classification for the third project.
|
| Third Project Position Title and Workers Supervised | Text |
Enter your position title for the third project and the number of workers you supervised.
|
| Third Project Detailed Description | Text |
Provide a detailed description of the third project and the work you supervised.
|
| Third Project Contract Amount | Number |
Enter the contract amount for the third project.
|
| Third Project Supervisory Experience (Years/Months) | Text |
Enter the amount of supervisory experience for the third project in years and months.
|
| Classification Requested | ||
| Classification Requested - C (Specify) | Text |
Enter the specific contractor license classification being requested under option C. Fill only if 'C - (Specify)' is 'Yes'.
Depends on:
C - (Specify)
|
| A - General Engineering | Radiobutton |
Check this box if the applicant is requesting the A (General Engineering) contractor classification.
|
| B - General Building | Radiobutton |
Check this box if the applicant is requesting the B (General Building) contractor classification.
|
| C - (Specify) | Radiobutton |
Check this box if the applicant is requesting a C classification and enter the specific C classification in the blank line provided.
|
| Classification Requested: "A" General Engineering | Radiobutton |
Check this box if you are requesting the "A" General Engineering classification. Fill only if 'Classification(s) requested' is 'A - General Engineering'.
Depends on:
Requested Classification 1 - Classification Name
|
| Classification Requested: "B" General Building | Radiobutton |
Check this box if you are requesting the "B" General Building classification. Fill only if 'Classification(s) requested' is 'B - General Building'.
Depends on:
Requested Classification 1 - Classification Name
|
| Classification Requested: "C" | Radiobutton |
Check this box if you are requesting the "C" classification. Fill only if 'Classification(s) requested' is 'C'.
Depends on:
Requested Classification 1 - Classification Name
|
| Classification Requested - Class C Specialty | Text |
Enter the specific Class C specialty classification being requested. Fill only if 'Classification Requested: "C"' is 'Yes'.
Depends on:
Classification Requested: "C"
|
| "A" General Engineering | Radiobutton |
Check this box if you are requesting the "A" General Engineering classification.
|
| "B" General Building | Radiobutton |
Check this box if you are requesting the "B" General Building classification.
|
| "C" | Radiobutton |
Check this box if you are requesting the "C" classification.
|
| Classification Requested - Option C (Specify) | Text |
Enter the specific classification being requested if selecting option "C" instead of the listed "A" or "B" classifications. Fill only if '"C"' is 'Yes'.
Depends on:
"C"
|
| Classification Requesting (A/B/C Selection and C Description) | ||
| Classification C Description | Text |
Enter the specific contractor classification being requested if selecting option C. Fill only if 'Classification requesting: C - (Specify)' is 'Yes'.
Depends on:
Classification requesting: C - (Specify)
|
| Classification requesting: A - General Engineering | Radiobutton |
Check this box if you are requesting the A (General Engineering) contractor license classification.
|
| Classification requesting: B - General Building | Radiobutton |
Check this box if you are requesting the B (General Building) contractor license classification.
|
| Classification requesting: C - (Specify) | Radiobutton |
Check this box if you are requesting a C classification and write the specific C classification on the line provided.
|
| CPA/PA Certification (Signature, Name, License, State) | ||
| CPA/PA Printed Name | Text |
Enter the printed full name of the CPA or PA who signed the certification.
|
| CPA/PA Signature | Text |
Enter the signature of the licensed Certified Public Accountant (CPA) or Public Accountant (PA) certifying the financial statement.
|
| CPA/PA License State | Text |
Enter the state in which the CPA/PA license was issued.
|
| CPA/PA License Number | Text |
Enter the CPA/PA professional license number.
|
| Current Assets | ||
| Current Assets - Cash (Including Checking Account) | Number |
Enter the total amount of cash on hand and in checking accounts.
|
| Current Assets - Savings Account | Number |
Enter the total balance held in savings accounts.
|
| Current Assets - Time Certificates (Within 1 Year) | Number |
Enter the total value of time certificates (such as CDs) maturing within one year.
|
| Current Assets - Deposit With Bids | Number |
Enter the total amount of any deposits made in connection with bids.
|
| Current Assets - Accounts Receivable (Completed Contracts) | Number |
Enter the total accounts receivable related to completed contracts.
|
| Current Assets - Total Cash | Number |
Enter the total cash amount, combining cash/checking, savings, time certificates, and bid deposits.
|
| Current Assets - Earned Estimated & Retainage (Uncompleted Contracts) | Number |
Enter the total earned estimated amounts and retainage due from uncompleted contracts.
|
| Current Assets - Other Accounts Receivable | Number |
Enter the total of all other accounts receivable not already listed.
|
| Current Assets - Work in Progress (Unbilled) | Number |
Enter the total value of work in progress that has not yet been billed.
|
| Current Assets - Notes Receivable | Number |
Enter the total amount of notes receivable due to the business.
|
| Current Assets - Stocks and Bonds | Number |
Enter the total market value of stocks and bonds held as current assets.
|
| Current Assets - Life Insurance (Cash Value) | Number |
Enter the total cash surrender value of any life insurance policies owned.
|
| Current Assets - Other Current Assets | Number |
Enter the total value of any other current assets not listed elsewhere in this section.
|
| Current Assets - Total Current Assets | Number |
Enter the total value of all current assets reported in this section.
|
| Current Liabilities - Accounts Payable | ||
| Accounts Payable - Subcontractors | Number |
Enter the amount currently owed to subcontractors as accounts payable.
|
| Accounts Payable - Material Men | Number |
Enter the amount currently owed to material suppliers as accounts payable.
|
| Accounts Payable - Others | Number |
Enter the amount currently owed to other vendors or payees not listed above as accounts payable.
|
| Total Accounts Payable | Number |
Enter the total accounts payable amount for all categories listed (subcontractors, material men, and others).
|
| Current Liabilities - Notes Payable | ||
| Notes Payable (Due Within One Year) - To Banks (Regular) | Number |
Enter the total amount of notes payable due within one year owed to banks (regular loans/notes).
|
| Notes Payable (Due Within One Year) - To Material Men | Number |
Enter the total amount of notes payable due within one year owed to material suppliers.
|
| Notes Payable (Due Within One Year) - To Other (Excluding Equipment) | Number |
Enter the total amount of notes payable due within one year owed to other parties, excluding any equipment-related notes.
|
| Total Notes Payable (Due Within One Year) | Number |
Enter the total notes payable due within one year, summing the amounts owed to banks, material suppliers, and other parties.
|
| Current Liabilities - Other and Totals | ||
| Current Maturities of Long-Term Debt | Number |
Enter the total dollar amount of long-term debt that will mature (be due) within the next one year.
|
| Other Current Liabilities - Description (Line 1) | Text |
Describe the other current liability item(s) not listed above.
|
| Other Current Liabilities - Description (Line 2) | Text |
Provide any additional description for the other current liability item(s) if more space is needed.
|
| Accrued Payrolls | Number |
Enter the total dollar amount of payroll expenses that have been incurred but not yet paid.
|
| Federal and State Income Tax Payable | Number |
Enter the total dollar amount of federal and state income taxes currently owed.
|
| Payroll Taxes Payable | Number |
Enter the total dollar amount of payroll taxes owed (including FICA, SUI, and withheld income taxes).
|
| Other Accrued Taxes, Interest, etc. | Number |
Enter the total dollar amount of any other accrued liabilities such as taxes, interest, or similar items.
|
| Encumbrances on Equipment (Due Within 1 Year) | Number |
Enter the total dollar amount of equipment-related encumbrances or obligations due within the next one year.
|
| Other Current Liabilities Amount | Number |
Enter the total dollar amount for the other current liabilities described.
|
| Total Current Liabilities | Number |
Enter the total dollar amount of all current liabilities.
|
| Detailed Description of Applicant Experience | ||
| Applicant Experience Detailed Description | Text |
Provide a detailed narrative describing the applicant’s on-site supervision and direction of employees experience in the classification indicated above.
|
| Detailed Description of Applicant Experience | Text |
Provide a detailed narrative of the applicant’s on-site supervision and direction of employees in the classification indicated above, including the kinds of work performed and responsibilities.
|
| Detailed Experience Description | ||
| Detailed Experience Description | Text |
Provide a detailed narrative of the applicant’s experience performing on-site supervision and directing employees in the classification indicated above (e.g., General Engineering or General Building).
|
| Education/Training First Entry | ||
| Education/Training First Entry - School or Training Program | Text |
Enter the name of the vocational school, college, university, or special training program for the first education/training entry.
|
| Education/Training First Entry - Months | Text |
Enter the number of additional months completed in the first education/training entry.
|
| Education/Training First Entry - Years | Text |
Enter the number of years completed in the first education/training entry.
|
| Education/Training Second Entry | ||
| Education/Training Second Entry - Months Attended | Text |
Enter the number of additional months attended or completed (beyond full years) for the second education/training entry.
|
| Education/Training Second Entry - Years Attended | Text |
Enter the number of years attended or completed for the second education/training entry.
|
| Education/Training Second Entry - School/Program Name | Text |
Enter the name of the vocational school, college, university, or special training program for the second education/training entry.
|
| Education/Training Third Entry | ||
| Third Education/Training Months | Text |
Enter the total number of additional months completed for the third education/training entry.
|
| Third Education/Training Years | Text |
Enter the total number of years completed for the third education/training entry.
|
| Third Education/Training Institution | Text |
Enter the name of the vocational school, college, university, or special training program for the third education/training entry.
|
| Employment Dates and Length of Service | ||
| Employment Start Date (Month/Year) | Text |
Enter the month and year the applicant's employment began.
|
| Employment End Date (Month/Year) | Text |
Enter the month and year the applicant's employment ended.
|
| Length of Service (Years) | Text |
Enter the total number of years the applicant worked during this employment period.
|
| Length of Service (Months) | Text |
Enter the additional number of months the applicant worked during this employment period.
|
| Employment Dates and Service Duration | ||
| Employment Start Date | Date |
Enter the date the applicant started employment for the experience being certified.
|
| Employment End Date | Date |
Enter the date the applicant ended employment for the experience being certified.
|
| Length of Service (Years) | Text |
Enter the total length of service in years for the employment period being certified.
|
| Length of Service (Months) | Text |
Enter the remaining length of service in months (in addition to the years) for the employment period being certified.
|
| Supervision Start Date | Date |
Enter the date the applicant began being supervised by you.
|
| Supervision End Date | Date |
Enter the date the applicant stopped being supervised by you.
|
| Total Time | Number |
Enter the total amount of time being claimed for this experience entry.
|
| Employment Dates, Service Length, and Work Time | ||
| Employment Start Date | Date |
Enter the date the applicant’s employment began.
|
| Employment End Date | Date |
Enter the date the applicant’s employment ended.
|
| Length of Service (Years) | Text |
Enter the total number of years the applicant worked during this period.
|
| Length of Service (Months) | Text |
Enter the additional number of months the applicant worked beyond the years entered.
|
| Supervision Start Date | Date |
Enter the date when the applicant began being supervised by you.
|
| Supervision End Date | Date |
Enter the date when the applicant’s supervision by you ended.
|
| Total Time | Text |
Enter the total time the applicant worked under this experience record.
|
| Full-time | Checkbox |
Check this box if the applicant worked full-time during the employment/service period being certified.
|
| Part-time | Checkbox |
Check this box if the applicant worked part-time during the employment/service period being certified (and provide hours per week if requested).
|
| Part-Time Hours per Week | Text |
If the applicant worked part-time, enter the average number of hours worked per week. Fill only if 'Part-time' is 'Yes'.
Depends on:
Part-time
|
| Employment Type (Full-Time or Part-Time and Hours) | ||
| Employment Type: Full-Time | Checkbox |
Check this box if the applicant worked full-time during the stated employment period.
|
| Employment Type: Part-Time | Checkbox |
Check this box if the applicant worked part-time during the stated employment period and enter the hours per week.
|
| Part-Time Hours per Week | Number |
Enter the number of hours per week the applicant worked if the employment was part-time. Fill only if 'Employment Type: Part-Time' is 'Yes'.
Depends on:
Employment Type: Part-Time
|
| Experience - Apprentice Duration | ||
| Apprentice | Checkbox |
Check this box if you have worked as an apprentice and will enter the number of years and months you worked in that role.
|
| Apprentice Duration (Years) | Text |
Enter the total number of years you have worked as an apprentice.
|
| Apprentice Duration (Months) | Text |
Enter the additional number of months you have worked as an apprentice beyond the years entered.
|
| Experience - Contractor Duration | ||
| Contractor | Checkbox |
Check this box if you have worked as a contractor, then enter the number of years and months in the blanks provided.
|
| Contractor Duration (Years) | Text |
Enter the total number of years you have worked as a contractor.
|
| Contractor Duration (Months) | Text |
Enter the additional number of months you have worked as a contractor beyond the years listed.
|
| Experience - Foreman Duration | ||
| Foreman | Checkbox |
Check this box if you have worked as a foreman and will provide the number of years and months of foreman experience.
|
| Foreman Duration (Years) | Text |
Enter the number of years you have worked as a foreman.
|
| Foreman Duration (Months) | Text |
Enter the number of additional months you have worked as a foreman.
|
| Experience - Journeyman Duration | ||
| Journeyman | Checkbox |
Check this box if you have worked as a journeyman and are reporting the number of years and months in that role.
|
| Journeyman Experience (Years) | Text |
Enter the total number of years you have worked as a journeyman.
|
| Journeyman Experience (Months) | Text |
Enter the additional number of months you have worked as a journeyman beyond the full years listed.
|
| Experience - Other Role Duration | ||
| Other Role Duration (Years) | Text |
Enter the number of years you worked in the other role.
|
| Other Role Duration (Months) | Text |
Enter the number of additional months you worked in the other role.
|
| Other Role Title | Text |
Enter the title or name of the other role you have worked as.
|
| Experience - Project Manager Duration | ||
| Project Manager Duration (Months) | Text |
Enter the number of additional months you have worked as a project manager beyond the years listed.
|
| Project Manager Duration (Years) | Text |
Enter the number of years you have worked as a project manager.
|
| Project Manager | Checkbox |
Check this box if you have worked as a Project Manager and will provide the number of years and months of experience in that role.
|
| Experience - Superintendent Duration | ||
| Superintendent for | Checkbox |
Check this box if you have worked as a superintendent, and then enter the total time you worked in years and months.
|
| Superintendent Duration (Years) | Text |
Enter the total number of years you have worked as a superintendent.
|
| Superintendent Duration (Months) | Text |
Enter the additional number of months you have worked as a superintendent beyond the years listed.
|
| Experience - Supervisor Duration | ||
| Supervisor | Checkbox |
Check this box if you have worked as a supervisor and will enter the number of years and months of that experience.
|
| Supervisor Duration (Years) | Text |
Enter the number of years you have worked as a supervisor.
|
| Supervisor Duration (Months) | Text |
Enter the number of additional months you have worked as a supervisor.
|
| Financial Statement Date | ||
| Financial Statement Date (Month/Day) | Text |
Enter the month and day for the effective date of the financial statement.
|
| Financial Statement Date (Year) | Text |
Enter the year portion of the effective date of the financial statement.
|
| Financial Statement Header (Date and Applicant Name) | ||
| Applicant Name | Text |
Enter the full legal name of the applicant for whom this financial statement is prepared. Fill only if 'Name of Applicant (First, Middle, Last)' matches the name listed on the application under 'Name of Applicant'.
Depends on:
Applicant Name (First, Middle, Last)
|
| Financial Statement As-of Date (Month/Day) | Text |
Enter the month and day for the financial statement “as of” date shown before the comma.
|
| Financial Statement As-of Year (20__) | Text |
Enter the last two digits of the year for the financial statement “as of” date shown after “20”.
|
| Fixed Assets | ||
| Total Fixed Assets | Number |
Enter the total value of all fixed assets.
|
| Equipment (Net Book Value) | Number |
Enter the total value of equipment at net book value.
|
| Real Estate | Number |
Enter the total value of real estate owned.
|
| Furniture and Fixtures (Net Book Value) | Number |
Enter the total value of furniture and fixtures at net book value.
|
| Tools | Number |
Enter the total value of tools owned.
|
| Other Fixed Assets | Number |
Enter the total value of any other fixed assets not listed above.
|
| For Office Use Only Documents | ||
| For Office Use Only - Financial Statement | Text |
Enter the office notation (such as initials, date received, or tracking note) indicating the applicant’s financial statement document was received/reviewed.
|
| For Office Use Only - Tax Clearance | Text |
Enter the office notation (such as initials, date received, or tracking note) indicating the applicant’s tax clearance document was received/reviewed.
|
| For Office Use Only - Experience | Text |
Enter the office notation (such as initials, date received, or tracking note) indicating the applicant’s experience documentation was received/reviewed.
|
| For Office Use Only - Credit Report | Text |
Enter the office notation (such as initials, date received, or tracking note) indicating the applicant’s credit report was received/reviewed.
|
| Full-Time / Part-Time Hours | ||
| Full-Time | Checkbox |
Check this box if the applicant worked full-time during the period being certified.
|
| Part-Time | Checkbox |
Check this box if the applicant worked part-time during the period being certified (and provide hours per week if requested).
|
| Part-Time Hours per Week | Number |
Enter the number of hours per week the applicant worked if the employment was part-time. Fill only if 'Part-Time' is 'Yes'.
Depends on:
Part-Time
|
| General | ||
| TextField2 | Text | |
| TextField2 | Text | |
| TextField2 | Text | |
| TextField2 | Text | |
| TextField2 | Text | |
| TextField2 | Text | |
| TextField2 | Text | |
| TextField2 | Text | |
| TextField2 | Text | |
| TextField2 | Text | |
| Doc. Description | Text | |
| TextField4 | Text | |
| TextField2 | Text | |
| TextField2 | Text | |
| TextField2 | Text | |
| TextField2 | Text | |
| TextField2 | Text | |
| TextField2 | Text | |
| TextField2 | Text | |
| TextField2 | Text | |
| TextField2 | Text | |
| TextField2 | Text | |
| Doc. Description | Text | |
| TextField4 | Text | |
| TextField2 | Text | |
| TextField2 | Text | |
| TextField2 | Text | |
| TextField2 | Text | |
| TextField2 | Text | |
| TextField2 | Text | |
| TextField2 | Text | |
| TextField2 | Text | |
| TextField2 | Text | |
| TextField2 | Text | |
| Doc. Description | Text | |
| TextField4 | Text | |
| Print Form | Button | |
| Honesty / Truthfulness / Integrity Confirmation | ||
| Honesty/Truthfulness/Integrity Confirmation - Yes | Radiobutton |
Check this box if the applicant demonstrated a history of honesty, truthfulness, financial integrity, and fair dealing.
|
| Honesty/Truthfulness/Integrity Confirmation - No | Radiobutton |
Check this box if the applicant did not demonstrate a history of honesty, truthfulness, financial integrity, and fair dealing.
|
| Honesty and Integrity History (Yes/No) | ||
| Honesty and Integrity History: Yes | Radiobutton |
Check this box if the applicant demonstrated a history of honesty, truthfulness, financial integrity, and fair dealing.
|
| Honesty and Integrity History: No | Radiobutton |
Check this box if the applicant did not demonstrate a history of honesty, truthfulness, financial integrity, and fair dealing.
|
| Honesty/Integrity History Confirmation (Yes/No) | ||
| Honesty/Integrity History Confirmation - Yes | Radiobutton |
Check this box if the applicant demonstrated a history of honesty, truthfulness, financial integrity, and fair dealing.
|
| Honesty/Integrity History Confirmation - No | Radiobutton |
Check this box if the applicant did not demonstrate a history of honesty, truthfulness, financial integrity, and fair dealing.
|
| Intended Contracting Business Description | ||
| Intended Contracting Business Description (Line 1) | Text |
Enter the first line of a detailed description of the kind of contracting business you intend to engage in.
|
| Intended Contracting Business Description (Line 2) | Text |
Enter the second line of a detailed description of the kind of contracting business you intend to engage in.
|
| Journeyman-Level Knowledge and Skill Confirmation | ||
| Journeyman-Level Knowledge and Skill Confirmation - Yes | Radiobutton |
Check this box if the applicant demonstrated the level of knowledge and skill expected of a journeyman or better in the listed craft(s) of trade.
|
| Journeyman-Level Knowledge and Skill Confirmation - No | Radiobutton |
Check this box if the applicant did not demonstrate the level of knowledge and skill expected of a journeyman or better in the listed craft(s) of trade.
|
| Knowledge and Skill Level (Yes/No) | ||
| Knowledge and Skill Level - Yes | Radiobutton |
Check this box if the applicant demonstrated the level of knowledge and skill expected of a journeyman or better in the craft(s) listed above.
|
| Knowledge and Skill Level - No | Radiobutton |
Check this box if the applicant did not demonstrate the level of knowledge and skill expected of a journeyman or better in the craft(s) listed above.
|
| Knowledge and Skill Level Confirmation (Yes/No) | ||
| Knowledge and Skill Level Confirmation: Yes | Radiobutton |
Check this box if the applicant demonstrated the level of knowledge and skill expected of a journeyman or better in the trade(s) listed above.
|
| Knowledge and Skill Level Confirmation: No | Radiobutton |
Check this box if the applicant did not demonstrate the level of knowledge and skill expected of a journeyman or better in the trade(s) listed above.
|
| Long-Term Liabilities | ||
| Long-Term Liabilities - Long-Term Debt (Less Portion Due Within One Year) | Number |
Enter the total amount of long-term debt outstanding, excluding any portion due within the next year.
|
| Long-Term Liabilities - Encumbrances on Equipment (Due After 1 Year) | Number |
Enter the total amount of liens or encumbrances on equipment that are due after one year.
|
| Long-Term Liabilities - Encumbrances on Real Estate | Number |
Enter the total amount of liens or encumbrances on real estate.
|
| Long-Term Liabilities - Billings in Excess of Cost on Uncompleted Contracts | Number |
Enter the total amount billed to date that exceeds costs incurred on uncompleted contracts.
|
| Long-Term Liabilities - Other and Totals | ||
| Other Long-Term Liabilities (Specify) - Line 1 | Text |
Enter a description of any other long-term liability not listed above.
|
| Other Long-Term Liabilities (Specify) - Line 2 | Text |
Enter an additional description of other long-term liabilities if more space is needed.
|
| Other Long-Term Liabilities Amount | Number |
Enter the total dollar amount of the other long-term liabilities described in the specify lines.
|
| Total Long-Term Liabilities | Number |
Enter the total dollar amount of all long-term liabilities.
|
| Total Liabilities | Number |
Enter the total dollar amount of all liabilities, including current and long-term liabilities.
|
| Most Recent Experience - Average Gross Dollar Value of Completed Projects | ||
| Most Recent Experience - Average Gross Dollar Value of Completed Projects | Number |
Enter the average gross dollar amount of the completed projects for this most recent work experience.
|
| Most Recent Experience - Average Size of Completed Projects | ||
| Average Size of Completed Projects | Text |
Enter the average physical size of the completed projects (e.g., square footage or another description of project dimensions).
|
| Most Recent Experience - Company Information | ||
| Most Recent Experience Company Name | Text |
Enter the name of the company for your most recent work experience.
|
| Most Recent Experience Company License Number | Text |
Enter the company’s license number associated with your most recent work experience.
|
| Most Recent Experience Business Type | Text |
Enter the type of business the company is engaged in for your most recent work experience.
|
| Most Recent Experience Company Address | Text |
Enter the full address of the company for your most recent work experience.
|
| Most Recent Experience Company Name | Text |
Enter the name of the company for your most recent work experience. Fill only if 'Classification(s) requested' is not 'Asbestos contractor'.
Depends on:
Requested Classification 1 - Classification Name
|
| Most Recent Experience Company License Number | Text |
Enter the company’s license number, if applicable. Fill only if 'Classification(s) requested' is not 'Asbestos contractor'.
Depends on:
Requested Classification 1 - Classification Name
|
| Most Recent Experience Type of Business | Text |
Describe the type of business or industry the company is engaged in. Fill only if 'Classification(s) requested' is not 'Asbestos contractor'.
Depends on:
Requested Classification 1 - Classification Name
|
| Most Recent Experience Company Address | Text |
Enter the company’s full address. Fill only if 'Classification(s) requested' is not 'Asbestos contractor'.
Depends on:
Requested Classification 1 - Classification Name
|
| Most Recent Experience - Duties and Responsibilities | ||
| Most Recent Experience Duties and Responsibilities (Line 1) | Text |
Enter the first line of your duties and responsibilities for your most recent work experience.
|
| Most Recent Experience Duties and Responsibilities (Line 2) | Text |
Enter the second line of your duties and responsibilities for your most recent work experience.
|
| Most Recent Experience Duties and Responsibilities (Line 3) | Text |
Enter the third line of your duties and responsibilities for your most recent work experience.
|
| Most Recent Experience Duties and Responsibilities (Line 4) | Text |
Enter the fourth line of your duties and responsibilities for your most recent work experience.
|
| Most Recent Experience Duties and Responsibilities (Line 5) | Text |
Enter the fifth line of your duties and responsibilities for your most recent work experience.
|
| Most Recent Experience Duties and Responsibilities (Line 6) | Text |
Enter the sixth line of your duties and responsibilities for your most recent work experience.
|
| Most Recent Experience Duties and Responsibilities (Line 7) | Text |
Enter the seventh line of your duties and responsibilities for your most recent work experience.
|
| Most Recent Experience Duties and Responsibilities (Line 8) | Text |
Enter the eighth line of your duties and responsibilities for your most recent work experience.
|
| Most Recent Experience Duties and Responsibilities (Line 1) | Text |
Enter a description of your job duties and responsibilities for this most recent experience (first line). Fill only if 'Classification(s) requested' is not 'Asbestos contractor'.
Depends on:
Requested Classification 1 - Classification Name
|
| Most Recent Experience Duties and Responsibilities (Line 2) | Text |
Enter additional job duties and responsibilities for this most recent experience (second line). Fill only if 'Classification(s) requested' is not 'Asbestos contractor'.
Depends on:
Requested Classification 1 - Classification Name
|
| Most Recent Experience Duties and Responsibilities (Line 3) | Text |
Enter additional job duties and responsibilities for this most recent experience (third line). Fill only if 'Classification(s) requested' is not 'Asbestos contractor'.
Depends on:
Requested Classification 1 - Classification Name
|
| Most Recent Experience Duties and Responsibilities (Line 4) | Text |
Enter additional job duties and responsibilities for this most recent experience (fourth line). Fill only if 'Classification(s) requested' is not 'Asbestos contractor'.
Depends on:
Requested Classification 1 - Classification Name
|
| Most Recent Experience Duties and Responsibilities (Line 5) | Text |
Enter additional job duties and responsibilities for this most recent experience (fifth line). Fill only if 'Classification(s) requested' is not 'Asbestos contractor'.
Depends on:
Requested Classification 1 - Classification Name
|
| Most Recent Experience Duties and Responsibilities (Line 6) | Text |
Enter additional job duties and responsibilities for this most recent experience (sixth line). Fill only if 'Classification(s) requested' is not 'Asbestos contractor'.
Depends on:
Requested Classification 1 - Classification Name
|
| Most Recent Experience Duties and Responsibilities (Line 7) | Text |
Enter additional job duties and responsibilities for this most recent experience (seventh line). Fill only if 'Classification(s) requested' is not 'Asbestos contractor'.
Depends on:
Requested Classification 1 - Classification Name
|
| Most Recent Experience Duties and Responsibilities (Line 8) | Text |
Enter additional job duties and responsibilities for this most recent experience (eighth line). Fill only if 'Classification(s) requested' is not 'Asbestos contractor'.
Depends on:
Requested Classification 1 - Classification Name
|
| Most Recent Experience - Employment Dates (Employed and Supervised) | ||
| Most Recent Experience - Dates Employed (From) | Date |
Enter the start date of your employment with this company for your most recent experience entry. Fill only if 'Classification(s) requested' is not 'Asbestos contractor'.
Depends on:
Requested Classification 1 - Classification Name
|
| Most Recent Experience - Dates Employed (To) | Date |
Enter the end date of your employment with this company for your most recent experience entry. Fill only if 'Classification(s) requested' is not 'Asbestos contractor'.
Depends on:
Requested Classification 1 - Classification Name
|
| Most Recent Experience - Total Time Employed | Text |
Enter the total length of time you were employed with this company (in years and months) for your most recent experience entry. Fill only if 'Classification(s) requested' is not 'Asbestos contractor'.
Depends on:
Requested Classification 1 - Classification Name
|
| Most Recent Experience - Dates Supervised (From) | Date |
Enter the start date of the period during which you supervised work at this company for your most recent experience entry. Fill only if 'Classification(s) requested' is not 'Asbestos contractor'.
Depends on:
Requested Classification 1 - Classification Name
|
| Most Recent Experience - Dates Supervised (To) | Date |
Enter the end date of the period during which you supervised work at this company for your most recent experience entry. Fill only if 'Classification(s) requested' is not 'Asbestos contractor'.
Depends on:
Requested Classification 1 - Classification Name
|
| Most Recent Experience - Total Time Supervised | Text |
Enter the total length of time you supervised work at this company (in years and months) for your most recent experience entry. Fill only if 'Classification(s) requested' is not 'Asbestos contractor'.
Depends on:
Requested Classification 1 - Classification Name
|
| Most Recent Experience - Employment/Supervision Dates, Totals, People Supervised, Hours per Week | ||
| Most Recent Experience - Dates Employed From | Date |
Enter the start date of your employment with this company for your most recent experience entry.
|
| Most Recent Experience - Dates Employed To | Date |
Enter the end date of your employment with this company for your most recent experience entry.
|
| Most Recent Experience - Total Time Employed | Text |
Enter the total length of time you were employed with this company for your most recent experience entry.
|
| Most Recent Experience - Dates Supervised From | Date |
Enter the start date of the period during which you supervised work for this most recent experience entry.
|
| Most Recent Experience - Dates Supervised To | Date |
Enter the end date of the period during which you supervised work for this most recent experience entry.
|
| Most Recent Experience - Total Time Supervising | Text |
Enter the total length of time you supervised work during this most recent experience entry.
|
| Most Recent Experience - Number of People Supervised | Text |
Enter the number of people you supervised during this most recent experience entry.
|
| Most Recent Experience - Hours Worked Per Week | Text |
Enter the average number of hours you worked per week during this most recent experience entry.
|
| Most Recent Experience - Number of People Supervised | ||
| Most Recent Experience - Number of People Supervised | Text |
Enter the number of people you supervised in this most recent work experience. Fill only if 'Classification(s) requested' is not 'Asbestos contractor'.
Depends on:
Requested Classification 1 - Classification Name
|
| Most Recent Experience - Project Metrics (Hours, Average Size, Average Value) | ||
| Hours Worked Per Week | Text |
Enter the typical number of hours you worked per week in this most recent position/experience. Fill only if 'Classification(s) requested' is not 'Asbestos contractor'.
Depends on:
Requested Classification 1 - Classification Name
|
| Average Size of Completed Projects | Text |
Enter the average size of projects you completed, using square footage or another description of the project’s physical dimensions. Fill only if 'Classification(s) requested' is not 'Asbestos contractor'.
Depends on:
Requested Classification 1 - Classification Name
|
| Average Gross Dollar Value of Completed Projects | Number |
Enter the average gross dollar value of the projects you completed. Fill only if 'Classification(s) requested' is not 'Asbestos contractor'.
Depends on:
Requested Classification 1 - Classification Name
|
| Most Recent Experience - Type of Projects (Checkboxes and Other Specify) | ||
| Most Recent Experience - Apartments | Checkbox |
Check this box if your most recent work experience included apartment projects. Fill only if 'Classification(s) requested' is not 'Asbestos contractor'.
Depends on:
Requested Classification 1 - Classification Name
|
| Most Recent Experience - Office Buildings | Checkbox |
Check this box if your most recent work experience included office building projects. Fill only if 'Classification(s) requested' is not 'Asbestos contractor'.
Depends on:
Requested Classification 1 - Classification Name
|
| Most Recent Experience - Condominiums | Checkbox |
Check this box if your most recent work experience included condominium projects. Fill only if 'Classification(s) requested' is not 'Asbestos contractor'.
Depends on:
Requested Classification 1 - Classification Name
|
| Most Recent Experience - Remodeling | Checkbox |
Check this box if your most recent work experience included remodeling projects. Fill only if 'Classification(s) requested' is not 'Asbestos contractor'.
Depends on:
Requested Classification 1 - Classification Name
|
| Most Recent Experience - Custom | Checkbox |
Check this box if your most recent work experience included custom projects (custom-built work). Fill only if 'Classification(s) requested' is not 'Asbestos contractor'.
Depends on:
Requested Classification 1 - Classification Name
|
| Most Recent Experience - Tract Houses | Checkbox |
Check this box if your most recent work experience included tract house projects. Fill only if 'Classification(s) requested' is not 'Asbestos contractor'.
Depends on:
Requested Classification 1 - Classification Name
|
| Most Recent Experience - High Rise | Checkbox |
Check this box if your most recent work experience included high-rise projects. Fill only if 'Classification(s) requested' is not 'Asbestos contractor'.
Depends on:
Requested Classification 1 - Classification Name
|
| Most Recent Experience - Other (specify) | Checkbox |
Check this box if your most recent work experience included another type of project not listed, and write the type on the 'Other (specify)' line. Fill only if 'Classification(s) requested' is not 'Asbestos contractor'.
Depends on:
Requested Classification 1 - Classification Name
|
| Most Recent Experience Project Type - Other (Specify) | Text |
Enter the type of project performed if it is not listed among the provided project type options. Fill only if 'Most Recent Experience - Other (specify)' is 'Yes'.
Depends on:
Most Recent Experience - Other (specify)
|
| Most Recent Experience - Type of Projects (including Other Specify) | ||
| Most Recent Experience: Apartments | Checkbox |
Check this box if your most recent experience included apartment projects.
|
| Most Recent Experience: Office Buildings | Checkbox |
Check this box if your most recent experience included office building projects.
|
| Most Recent Experience: Condominiums | Checkbox |
Check this box if your most recent experience included condominium projects.
|
| Most Recent Experience: Remodeling | Checkbox |
Check this box if your most recent experience included remodeling projects.
|
| Most Recent Experience: Custom | Checkbox |
Check this box if your most recent experience included custom (custom-built) projects.
|
| Most Recent Experience: Tract Houses | Checkbox |
Check this box if your most recent experience included tract house projects.
|
| Most Recent Experience: High Rise | Checkbox |
Check this box if your most recent experience included high-rise projects.
|
| Most Recent Experience: Other (specify) | Checkbox |
Check this box if your most recent experience included another type of project not listed, and specify the project type on the provided line.
|
| Most Recent Experience - Other Project Type (Specify) | Text |
Enter the specific type of project you worked on if it is not listed among the provided project type options. Fill only if 'Most Recent Experience: Other (specify)' is 'Yes'.
Depends on:
Most Recent Experience: Other (specify)
|
| Net Worth | ||
| Net Worth - Total Liabilities and Net Worth | Number |
Enter the total dollar amount of liabilities plus net worth.
|
| Net Worth - Total Net Worth | Number |
Enter the total dollar amount of the applicant's net worth.
|
| Net Worth - Surplus | Number |
Enter the dollar amount of the applicant's surplus.
|
| Net Worth - Capital Stock | Number |
Enter the dollar amount of the applicant's capital stock (if a corporation, as applicable).
|
| Notary Acknowledgment (Subscribed and Sworn) Details | ||
| Acknowledgment Day of Month | Text |
Enter the day of the month on which the oath was subscribed and sworn before the notary.
|
| Acknowledgment Month | Text |
Enter the month in which the oath was subscribed and sworn before the notary.
|
| Acknowledgment Year (Last Two Digits) | Text |
Enter the last two digits of the year in which the oath was subscribed and sworn before the notary.
|
| Notary Signature | Text |
Provide the notary public’s signature for the acknowledgment.
|
| Notary State | Text |
Enter the state where the notary public is commissioned, as stated in the acknowledgment.
|
| Notary Commission Expiration Date | Date |
Enter the date on which the notary public’s commission expires.
|
| Notary Printed Name | Text |
Enter the notary public’s printed name.
|
| Notary Acknowledgment (Subscribed and Sworn) تفاصيل | ||
| Subscribed and Sworn Day | Text |
Enter the day of the month on which the oath/affirmation was subscribed and sworn before the notary.
|
| Subscribed and Sworn Month | Text |
Enter the month in which the oath/affirmation was subscribed and sworn before the notary.
|
| Subscribed and Sworn Year (20__) | Text |
Enter the last two digits of the year in which the oath/affirmation was subscribed and sworn before the notary.
|
| Notary Signature | Text |
Provide the notary public's signature for this acknowledgment.
|
| Notary State | Text |
Enter the state in which the notary public is commissioned.
|
| Notary Commission Expiration Date | Date |
Enter the date on which the notary public's commission expires.
|
| Notary Printed Name | Text |
Enter the notary public's name as it should be printed.
|
| Notary Acknowledgment (Subscribed/Sworn) Details | ||
| Subscribed/Sworn Day | Text |
Enter the day of the month on which the oath or affirmation was subscribed and sworn before the notary.
|
| Subscribed/Sworn Month | Text |
Enter the month in which the oath or affirmation was subscribed and sworn before the notary.
|
| Subscribed/Sworn Year | Text |
Enter the year in which the oath or affirmation was subscribed and sworn before the notary.
|
| Notary Signature | Text |
Provide the notary public's signature for this acknowledgment.
|
| Notary State | Text |
Enter the state where the notary public is commissioned.
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| Notary Commission Expiration Date | Date |
Enter the date on which the notary public's commission expires.
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| Notary Printed Name | Text |
Enter the notary public's name as it should be printed.
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| Notary Document Record (Doc/Pages/Court/Description/Signatures) | ||
| Doc. Date | Date |
Enter the date of the notarized document being recorded.
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| No. of Pages | Text |
Enter the total number of pages in the notarized document.
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| Notary Name | Text |
Enter the full name of the notary public.
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| Circuit Court | Text |
Enter the circuit court associated with the notarization (e.g., the circuit number or name).
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| Doc. Description | Text |
Provide a brief description of the document that was notarized.
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| Notary Signature | Text |
Enter the notary public’s signature as it should appear on the record.
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| Notary Signature Date | Date |
Enter the date the notary signed this record.
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| Notary Document Record Details | ||
| Document Date | Date |
Enter the date of the notarized document being recorded.
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| Number of Pages | Text |
Enter the total number of pages in the notarized document.
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| Notary Name | Text |
Enter the full name of the notary who performed the notarization.
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| Circuit Court | Text |
Enter the circuit court (name or circuit number) associated with this notarization record.
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| Document Description | Text |
Provide a brief description of the document being notarized (e.g., affidavit, certification, statement).
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| Notary Signature | Text |
Enter the notary’s signature as it appears on the notarization record.
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| Notary Record Date | Date |
Enter the date the notary signed or completed this document record entry.
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| Notary Document Recording Details | ||
| Document Date | Date |
Enter the date the document was recorded or filed.
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| Number of Pages | Text |
Enter the total number of pages in the recorded document.
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| Notary Name | Text |
Enter the full name of the notary associated with the recorded document.
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| Circuit Court | Text |
Enter the circuit court information for where the document was recorded (for example, the circuit number or court name).
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| Document Description | Text |
Provide a brief description of the document being recorded.
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| Notary Signature | Text |
Enter the notary's signature as it should appear for the recording details.
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| Notary Signature Date | Date |
Enter the date the notary signed the document for recording.
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| Other Assets | ||
| Inventory or Other Materials Amount | Number |
Enter the total dollar value of inventory or other materials included as other assets.
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| Material in Stock Amount | Number |
Enter the total dollar value of material in stock that is not included in any items listed above.
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| Other Assets Amount | Number |
Enter the total dollar value of any other assets not captured by the listed categories.
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| Total Other Assets | Number |
Enter the combined total dollar value of all items reported in the Other Assets section.
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| Print Name - Entity/RME/Sole Owner | ||
| Print Name - Entity | Text |
Enter the printed name of the business entity.
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| Print Name - RME | Text |
Enter the printed name of the Responsible Managing Employee (RME).
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| Print Name - Sole Owner | Text |
Enter the printed name of the sole owner.
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| Question 1 - At least 18 years of age (Yes/No) | ||
| Question 1 - Yes | Radiobutton |
Check this box if you are at least 18 years of age.
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| Question 1 - No | Radiobutton |
Check this box if you are not at least 18 years of age.
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| Question 10 - Assignment of assets in settlement for less than indebtedness (Yes/No) | ||
| Question 10 - Yes | Radiobutton |
Check this box if you (or a related construction organization) have ever made an assignment of assets in settlement of construction obligations for less than the total indebtedness.
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| Question 10 - No | Radiobutton |
Check this box if you (or a related construction organization) have not made an assignment of assets in settlement of construction obligations for less than the total indebtedness.
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| Question 11 - Convicted of a crime not annulled/expunged (Yes/No) | ||
| Question 11 - Yes | Radiobutton |
Check this box if you have ever been convicted of a crime in any jurisdiction that has not been annulled or expunged.
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| Question 11 - No | Radiobutton |
Check this box if you have not been convicted of a crime in any jurisdiction that has not been annulled or expunged.
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| Question 2 - U.S. citizen/national/authorized to work (Yes/No) | ||
| Question 2 - Yes | Radiobutton |
Check this box if you are a U.S. citizen, a U.S. national, or an alien authorized to work in the United States.
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| Question 2 - No | Radiobutton |
Check this box if you are not a U.S. citizen, not a U.S. national, and not an alien authorized to work in the United States.
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| Question 3 - Previously applied for Hawaii contractor's license (Yes/No and month/year) | ||
| Question 3 - Yes (Previously applied for Hawaii State contractor's license) | Radiobutton |
Check this box if you have previously applied for a Hawaii State contractor's license.
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| Question 3 - No (Previously applied for Hawaii State contractor's license) | Radiobutton |
Check this box if you have not previously applied for a Hawaii State contractor's license.
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| Question 3 - Month/Year Previously Applied | Text |
Enter the month and year you previously applied for a Hawaii State contractor's license, if you answered Yes to Question 3. Fill only if 'Question 3 - Yes (Previously applied for Hawaii State contractor's license)' is 'Yes'.
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| Question 4 - Affiliated with terminated contractor/license court order (Yes/No) | ||
| Question 4 - Yes | Radiobutton |
Check this box if you have ever been affiliated with a contracting entity whose license was terminated due to a court order authorizing payment from the Contractors Recovery Fund (in this state or any other state).
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| Question 4 - No | Radiobutton |
Check this box if you have never been affiliated with a contracting entity whose license was terminated due to a court order authorizing payment from the Contractors Recovery Fund (in this state or any other state).
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| Question 5 - License denied/fined/suspended/revoked (Yes/No) | ||
| Question 5 - Yes | Radiobutton |
Check this box if you or any construction organization in which you were an officer, partner, manager, or member has had a contractor’s or other professional/vocational license denied, fined, suspended, or revoked by any state.
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| Question 5 - No | Radiobutton |
Check this box if neither you nor any construction organization in which you were an officer, partner, manager, or member has had a contractor’s or other professional/vocational license denied, fined, suspended, or revoked by any state.
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| Question 6 - Bonding/surety financial settlement completed (Yes/No) | ||
| Question 6 - Yes | Radiobutton |
Check this box if a bonding or surety company has ever completed or made a financial settlement on any construction contract or work undertaken by you or a construction organization in which you were an officer, partner, manager, or member.
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| Question 6 - No | Radiobutton |
Check this box if no bonding or surety company has ever completed or made a financial settlement on any construction contract or work undertaken by you or a construction organization in which you were an officer, partner, manager, or member.
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| Question 7 - Unpaid past due bills/claims (Yes/No) | ||
| Question 7 - Yes (Unpaid past due bills/claims) | Radiobutton |
Check this box if there are currently any unpaid past due bills or claims for labor, materials, or services that are outstanding and unsatisfied as a result of your operations or an organization you were an officer/partner/manager/member of.
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| Question 7 - No (Unpaid past due bills/claims) | Radiobutton |
Check this box if there are no unpaid past due bills or claims for labor, materials, or services that are outstanding and unsatisfied as a result of your operations or an organization you were an officer/partner/manager/member of.
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| Question 8 - Liens/suits/judgments outstanding or pending (Yes/No) | ||
| Question 8 - Yes | Radiobutton |
Check this box if there are any liens, suits, or judgments (of record or pending) that are currently outstanding and unsatisfied related to your operations or a construction organization you were an officer, partner, manager, or member of.
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| Question 8 - No | Radiobutton |
Check this box if there are no liens, suits, or judgments (of record or pending) that are currently outstanding and unsatisfied related to your operations or a construction organization you were an officer, partner, manager, or member of.
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| Question 9 - Adjudicated bankrupt or in bankruptcy proceedings (Yes/No) | ||
| Question 9 - Yes | Radiobutton |
Check this box if you or any construction organization in which you were an officer, partner, manager, or member has ever been adjudicated bankrupt or is currently in bankruptcy proceedings.
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| Question 9 - No | Radiobutton |
Check this box if neither you nor any construction organization in which you were an officer, partner, manager, or member has ever been adjudicated bankrupt and none is currently in bankruptcy proceedings.
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| Release of Information - Applicant Signature and Date | ||
| Release of Information - Applicant Signature | Text |
Enter the applicant’s signature authorizing the release of application information to the specified third party.
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| Release of Information - Signature Date | Date |
Enter the date on which the applicant signed the release of information authorization.
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| Release of Information - Third Party Details | ||
| Third Party Assistant Name | Text |
Enter the full name of the individual who is assisting you and is authorized to receive information about your application.
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| Third Party Organization Name | Text |
Enter the name of the organization the authorized third party represents, if applicable.
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| Requested Classification | ||
| Requested Classification 1 - Symbol | Text |
Enter the classification symbol/code being requested (see list).
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| Requested Classification 1 - Classification Name | Text |
Enter the name of the classification that corresponds to the requested symbol.
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| Requested Classification (C) | Text |
Enter the requested contractor classification under option C. Fill only if 'C - Other (specify)' is 'Yes'.
Depends on:
C - Other (specify)
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| A - General Engineering | Radiobutton |
Check this box if the applicant is requesting the A (General Engineering) contractor classification.
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| B - General Building | Radiobutton |
Check this box if the applicant is requesting the B (General Building) contractor classification.
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| C - Other (specify) | Radiobutton |
Check this box if the applicant is requesting a C classification and enter the specific C classification on the line provided.
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| Skills (including Other Specify) | ||
| Read a financial statement | Checkbox |
Check this box if you can read and understand a financial statement.
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| Compute payroll | Checkbox |
Check this box if you are able to compute payroll.
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| Balance a checking account | Checkbox |
Check this box if you can balance a checking account.
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| Read blueprints | Checkbox |
Check this box if you can read and interpret construction blueprints.
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| Prepare job estimates | Checkbox |
Check this box if you can prepare job or project cost estimates.
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| Order materials | Checkbox |
Check this box if you can order the materials needed for a job or project.
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| Design & layout construction projects | Checkbox |
Check this box if you can design and lay out construction projects.
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| Other (specify) - 1 | Checkbox |
Check this box if you have another relevant skill not listed and you will specify it on the provided line.
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| Other (specify) - 2 | Checkbox |
Check this box if you have an additional other skill not listed and you will specify it on the provided line.
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| Other Skill (Specify) 1 - Line 2 | Text |
Enter any remaining text for the first additional skill (second line of the first “Other (specify)” entry). Fill only if 'Other (specify) - 1' is 'Yes'.
Depends on:
Other (specify) - 1
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| Other Skill (Specify) 2 - Line 2 | Text |
Enter any remaining text for the second additional skill (second line of the second “Other (specify)” entry). Fill only if 'Other (specify) - 2' is 'Yes'.
Depends on:
Other (specify) - 2
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| Other Skill (Specify) 1 - Line 1 | Text |
Enter the first additional skill you can perform (first line of the first “Other (specify)” entry). Fill only if 'Other (specify) - 1' is 'Yes'.
Depends on:
Other (specify) - 1
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| Other Skill (Specify) 2 - Line 1 | Text |
Enter the second additional skill you can perform (first line of the second “Other (specify)” entry). Fill only if 'Other (specify) - 2' is 'Yes'.
Depends on:
Other (specify) - 2
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| State License First Row | ||
| First Row State License - State Name | Text |
Enter the name of the state that issued the license listed in the first row.
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| First Row State License - License Number | Text |
Enter the state license number for the license listed in the first row.
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| First Row State License - Date Issued | Date |
Enter the date the state license in the first row was issued.
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| First Row State License - Classifications | Text |
Enter the classification(s) associated with the state license listed in the first row.
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| State License Fourth Row | ||
| 4th State License - State Name | Text |
Enter the name of the state where the 4th contractor license was issued.
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| 4th State License - License Number | Text |
Enter the license number for the 4th state contractor license.
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| 4th State License - Date Issued | Date |
Enter the date the 4th state contractor license was issued.
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| 4th State License - Classifications | Text |
Enter the classification(s) listed on the 4th state contractor license.
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| State License Second Row | ||
| Second Row State Name | Text |
Enter the name of the state in which the contractor license listed on this row was issued.
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| Second Row State License Number | Text |
Enter the contractor license number previously held in the state listed on this row.
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| Second Row Date Issued | Date |
Enter the date the contractor license on this row was originally issued.
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| Second Row Classifications | Text |
Enter the license classification(s) associated with the contractor license on this row.
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| State License Third Row | ||
| State License (Third Row) - State Name | Text |
Enter the name of the state where this contractor license was issued.
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| State License (Third Row) - License Number | Text |
Enter the contractor license number issued by the state listed in this row.
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| State License (Third Row) - Date Issued | Date |
Enter the date this contractor license was issued.
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| State License (Third Row) - Classifications | Text |
Enter the license classification(s) associated with this state contractor license.
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| Supervision Dates and Total Time | ||
| Supervision Start Date | Date |
Enter the date when you began supervising the applicant.
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| Supervision End Date | Date |
Enter the date when you stopped supervising the applicant.
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| Total Supervision Time | Number |
Enter the total amount of time you supervised the applicant for the period indicated.
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| Total Assets | ||
| Total Assets | Number |
Enter the total dollar amount of all assets (sum of total current assets, total other assets, and total fixed assets).
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| Total Time in Construction | ||
| Total Time in Construction (Years) | Text |
Enter the total number of years of construction experience you have.
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| Total Time in Construction (Months) | Text |
Enter the additional number of months of construction experience you have beyond the years listed.
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