Unidentified Document Instructions

Enter an alternate telephone number where you can be reached, including area code and extension if applicable.

Enter a fax number, including area code, where fax messages for you can be sent.

Enter an alternate email address that can be used to contact you (e.g., [email protected]).

Check this box when you are applying for a certified general contractor license and will be qualifying a business (use this when you will be qualifying only one business entity).

Check this box if the business is not already qualified in the relevant jurisdiction.

Check this box if the business is already qualified in the relevant jurisdiction; if checked, provide the existing license number in the License Number field below.

Enter the business contact’s email address to be used for correspondence and notifications.

Enter the business contact’s primary phone number, including area code and any extension if applicable.

Enter the full name of the business contact person who is different from the applicant (first and last name).

Enter the legal name of the business being qualified exactly as it appears on official records.

Enter the trade name or DBA under which the business operates if different from the legal business name, or leave blank if none.

Enter the business's federal employer identification number (FEIN/EIN) used for tax reporting.

Enter the state or territory for the business location (use the two-letter postal abbreviation if available).

Enter the ZIP Code for the business location and include the 4-digit extension after a hyphen if applicable.

If the business location is in Florida, enter the county name; otherwise leave this field blank or enter N/A. Fill only if 'Business Location State' is 'Florida'.

Enter the country where the business location is situated (for example, United States).

Enter the business location's street address, including suite or unit number if applicable.

Enter the city where the business location is physically located.

Enter the full legal name of Business Owner 1 as it appears on official records.

Enter the mailing or street address for Business Owner 1, including city, state, and ZIP as applicable.

Enter the Social Security Number (SSN) or Federal Employer Identification Number (FEIN) used to identify Business Owner 1 for tax purposes.

Enter the percentage of ownership that Business Owner 1 holds in the business; all owners' percentages must total 100%.

Enter the full legal name of the business owner for row 2 (individual or company name as applicable).

Provide the owner's mailing address for row 2, including street, city, state, and ZIP code.

Enter the owner's Social Security Number or Federal Employer Identification Number for row 2 (include dashes if required by the form).

Enter the percentage of ownership held by the person or entity listed in row 2 so that all owners' percentages total 100.

Enter the full legal name of the third listed business owner.

Enter the mailing address (street, city, state, ZIP) for the third listed business owner.

Enter the third owner's Social Security Number or Federal Employer Identification (FEID) used for identification or tax purposes.

Enter the percentage of business ownership held by the third listed owner.

Enter the full legal name of the business owner listed in row 4.

Enter the owner’s mailing address for row 4, including street address, city, state, and ZIP code.

Enter the owner’s Social Security Number or Federal Employer Identification (FEID) associated with this owner in row 4.

Enter the percentage of ownership that this owner holds in the business for row 4.

Enter the full legal name of the business owner listed in row 5.

Enter the mailing or business address for this owner, including street, city, state, and ZIP code.

Enter the owner's Social Security Number (SSN) or Federal Employer Identification Number (FEID) for the owner in row 5.

Enter the percent of ownership held by this owner; the ownership percentages for all owners must total 100.

Enter the full legal name of the business owner listed in row 6.

Enter the owner's complete mailing address (street, city, state, and ZIP) for the owner listed in row 6.

Enter the owner's Social Security Number or Federal Employer Identification Number (FEID), as applicable, for the owner listed in row 6.

Enter the percentage of ownership held by this owner; ensure the percentages for all owners add up to 100%.

Enter the full legal name of the business owner listed in row 7.

Provide the mailing or street address for the business owner listed in row 7.

Enter the owner's Social Security Number or Federal Employer Identification Number (FEID) as applicable for the owner in row 7.

Provide the percentage of the business owned by the person listed in row 7.

Check this box if the business is owned and operated by a single individual (sole proprietor).

Check this box if the business is organized as a limited liability company (LLC).

Check this box if the business is organized as a corporation.

Check this box if the business is structured as a partnership.

Enter the business type when it is not one of the listed options (for example, 'Nonprofit', 'Cooperative', 'LLC-Professional', etc.). Fill only if 'Other (please specify)' is 'Yes'.

Check this box if the business type is not listed and enter the specific type on the provided line.

Check this box if you have completed a financial responsibility course approved by the Construction Industry Licensing Board. Fill only if 'Submitted credit report shows credit score of 660 or higher — No' is 'No'.

Check this box if you have not completed a financial responsibility course approved by the Construction Industry Licensing Board.

Enter your primary telephone number (include area code and any necessary punctuation) where you can be reached for application-related contact.

Enter your primary email address that the Department may use to contact you about this application.

Enter the period you were employed by this employer as a start-to-end date range covering the job (e.g., month and year of hire through month and year of separation).

Enter the employer's full legal name and the complete mailing address (street, city, state, and ZIP) for the job listed.

Provide the employer's primary contact phone number, including area code and any extension if applicable.

Check this box if, for the listed employment, you served in the role of a worker on the project.

Check this box if, for the listed employment, you served in the role of a foreman on the project.

Enter the license number of your current certified residential or building contractor license when claiming the 'Upgrade Method' qualification. Fill only if is 'Yes'.

Check this box if the project included foundations or slabs larger than 20,000 square feet and you performed work on them.

Check this box if you performed or supervised column erection work on the project.

Check this box if you performed formwork for structural reinforced concrete on the project.

Check this box if you performed masonry wall work on the project.

Check this box if you performed steel erection work on the project.

Check this box if you performed work on elevated slabs as part of the project.

Check this box if the described experience was on structures that were four stories or higher.

Check this box if the described experience was not on structures that were four stories or higher.

Check this box if you performed or supervised foundation or slab work on a project where the slab area exceeded 20,000 square feet.

Check this box if you performed or supervised column erection work on this project.

Check this box if you performed or supervised construction of masonry walls on this project.

Check this box if you performed or supervised formwork related to structural reinforced concrete on this project.

Check this box if you performed or supervised construction of elevated slabs (slabs above grade) on this project.

Check this box if you performed or supervised steel erection work on this project.

Check if this explanation relates to person number 1.

Check if this explanation relates to person number 2.

Check if this explanation relates to person number 3.

Check if this explanation relates to person number 4.

Check if this explanation relates to person number 5.

Check if this explanation relates to person number 6.

Check if this explanation corresponds to Question 1 on the form.

Check if this explanation corresponds to Question 2 on the form.

Enter the name or brief title of the offense for which this explanation is being provided.

Enter the county where the offense occurred.

Enter the state where the offense occurred.

Enter the date when the offense occurred.

Provide the penalty, sentence, or final disposition imposed for the offense.

Check this box if all sanctions related to the offense have been satisfied.

Check this box if the sanctions related to the offense have not been satisfied.

Provide a detailed description of the incident, including relevant facts, circumstances, and any other information that explains the offense.

Enter the person number this explanation refers to (use this box when the appropriate person checkbox is not used).

Check this box if this explanation relates to person number 1.

Check this box if this explanation relates to person number 2.

Check this box if this explanation relates to person number 3.

Check this box if this explanation relates to person number 4.

Check this box if this explanation relates to person number 5.

Check this box if this explanation relates to person number 6.

Check this box if this explanation is provided in response to question number 1.

Check this box if this explanation is provided in response to question number 2.

Enter the name or brief description of the offense being explained.

Enter the county where the offense occurred.

Enter the state or jurisdiction where the offense occurred (use full name or standard abbreviation).

Enter the date when the offense occurred.

Provide the penalty, sentence, or final disposition imposed for the offense.

Check this box if all sanctions related to the offense have been satisfied.

Check this box if all sanctions related to the offense have not been satisfied.

Provide a detailed narrative describing the incident, including relevant facts, circumstances, and any other pertinent information.

Enter the number that identifies which person this explanation relates to (select 1–5 or enter the other number).

Check this box if this explanation relates to person number 1.

Check this box if this explanation relates to person number 2.

Check this box if this explanation relates to person number 3.

Check this box if this explanation relates to person number 4.

Check this box if this explanation relates to person number 5.

Check this box if the explanation relates to a person not listed and write that person's number on the blank line.

Check this box if this explanation is provided in response to Question 1.

Check this box if this explanation is provided in response to Question 2.

Enter the name or brief title of the offense or charge being explained.

Enter the name of the county where the offense occurred.

Enter the state where the offense occurred.

Enter the date when the offense occurred.

Provide the penalty, sentence or final disposition imposed for the offense.

Check this box if all sanctions related to the offense have been satisfied.

Check this box if not all sanctions related to the offense have been satisfied or some remain outstanding.

Provide a detailed description of the circumstances, facts, and any relevant details explaining this offense.

Enter the number of the person this explanation refers to (the numeric identifier that matches the persons listed elsewhere).

Enter the full name of the school or training provider that offered the approved financial responsibility course. Fill only if 'Completed financial responsibility course — Yes' is 'Yes'.

Enter the provider number or identification assigned to the school by the Construction Industry Licensing Board (or the provider's ID). Fill only if 'Completed financial responsibility course — Yes' is 'Yes'.

Provide the official title of the approved financial responsibility course you completed. Fill only if 'Completed financial responsibility course — Yes' is 'Yes'.

Enter the date or date range when you attended the financial responsibility course. Fill only if 'Completed financial responsibility course — Yes' is 'Yes'.

Check this box if the business already has an approved Financially Responsible Officer and you will provide that officer's name and license number on the form.

Enter the full name and license number of the business’s approved Financially Responsible Officer (provide both name and license number in this single field). Fill only if 'The business currently has an approved Financially Responsible Officer' is 'Yes'.

Check this box if the business does not yet have an approved Financially Responsible Officer but will appoint one and will provide the name of the proposed officer who will submit the CILB 8 application.

Enter the full name of the proposed Financially Responsible Officer who will be submitting the CILB 8 application for the business. Fill only if 'The business will appoint a Financially Responsible Officer' is 'Yes'.

Check this box if the business will not designate a Financially Responsible Officer and the primary qualifying agent will assume financial responsibility for the business organization.

Check this box when the explanation on this row applies to Person #1.

Check this box when the explanation on this row applies to Person #2.

Check this box when the explanation on this row is provided in response to Question #3.

Check this box when the explanation on this row is provided in response to Question #4.

Check this box when the explanation on this row applies to Person #5.

Check this box when the explanation on this row applies to Person #6.

Check this box when the explanation on this row applies to Person #7.

Check this box when the explanation on this row applies to Person #8.

Enter the name of the state, country, or jurisdiction relevant to this explanation (where the license was issued or the incident occurred).

Enter the application type and/or the license or application number associated with this explanation. Fill only if 'First Explanation - Question #4', 'First Explanation - Person #5' is 'Yes' any.

Provide a clear, detailed narrative describing the circumstances for the 'Yes' answer, including relevant dates, locations, names, and any supporting facts. Fill only if 'First Explanation - Person #1', 'First Explanation - Person #2', 'First Explanation - Question #3', 'First Explanation - Person #5', 'First Explanation - Person #6', 'First Explanation - Person #7', 'First Explanation - Person #8', 'First Explanation — Person Number' is 'Yes' any.

Enter the number (1–5) of the person this explanation relates to as shown on the main form.

Enter the type or category of the license or registration (for example, 'Contractor', 'Real Estate', 'Nurse', etc.).

Enter the state or jurisdiction that issued the license/registration (use the two‑letter state code or full state/jurisdiction name).

Enter the start date when this license/registration became effective.

Enter the start date when this license/registration became effective.

Enter the start date when this license/registration became effective.

Enter the end date when this license/registration ended, expired, or was last active.

Enter the end date when this license/registration ended, expired, or was last active.

Enter the end date when this license/registration ended, expired, or was last active.

Enter the license or registration number exactly as it appears on the credential.

Enter the full name that was used on the license/registration (if different from your current name).

Enter the prior last name (surname) you have used or been known by for this first prior name entry. Fill only if 'Prior Name - Yes' is 'Yes'.

Enter the prior first (given) name you have used or been known by for this first prior name entry. Fill only if 'Prior Name - Yes' is 'Yes'.

Enter the middle name or middle initial used with this prior name, or leave blank if none. Fill only if 'Prior Name - Yes' is 'Yes'.

Enter any title or salutation associated with this prior name (for example, Mr., Ms., Dr.), or leave blank if none. Fill only if 'Prior Name - Yes' is 'Yes'.

Enter any suffix associated with this prior name (for example, Jr., Sr., III), or leave blank if none. Fill only if 'Prior Name - Yes' is 'Yes'.

Enter the full name of the first qualifier (individual responsible for the business qualification). Fill only if 'Business Already Qualified — Yes' is 'Yes'.

Enter the license number under which the first qualifier is qualified for the business. Fill only if 'Business Already Qualified — Yes' is 'Yes'.

Enter the full name of the fourth qualifier (the individual or authorized representative under whom the business is qualified). Fill only if 'Business Already Qualified — Yes' is 'Yes'.

Enter the license or registration number associated with the fourth qualifier under which the business is qualified. Fill only if 'Business Already Qualified — Yes' is 'Yes'.

Enter your legal family/last name exactly as it appears on your official documents.

Enter your legal given/first name exactly as it appears on your official documents.

Enter your middle name or middle initial as it appears on legal documents, or leave blank if you have none.

Enter any name prefix or title used before your name (for example: Mr., Mrs., Ms., Dr.), or leave blank if none.

Enter any suffix that follows your name (for example: Jr., Sr., III, Esq.), or leave blank if none.

Check this box if the applicant's gender is male.

Check this box if the applicant's gender is female.

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.

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.

Check this box if you have obtained workers' compensation insurance, or have filed for an exemption with the Division of Workers' Compensation, or you attest you will obtain an exemption within 30 days after your license is issued.

Check this box if you have not obtained workers' compensation insurance, have not filed for an exemption, and do not attest to obtaining an exemption within 30 days after your license is issued.

Enter the job title or position you held on this specific project (for example: Carpenter, Foreman, Project Manager). Fill only if 'Foundation/Slabs greater than 20,000 sq. ft.', 'Column erection', 'Masonry walls', 'Formwork for structural reinforced concrete', 'Elevated slabs', 'Steel erection' is 'Yes' (any).

Provide a short summary of the main duties or responsibilities you performed on the project (one or two brief phrases). Fill only if 'Foundation/Slabs greater than 20,000 sq. ft.', 'Column erection', 'Masonry walls', 'Formwork for structural reinforced concrete', 'Elevated slabs', 'Steel erection' is 'Yes' (any).

Give a detailed description of the work you performed on the project, including specific tasks, scope of responsibilities, tools or methods used, and any supervisory or oversight roles. Fill only if 'Foundation/Slabs greater than 20,000 sq. ft.', 'Column erection', 'Masonry walls', 'Formwork for structural reinforced concrete', 'Elevated slabs', 'Steel erection' is 'Yes' (any).

Enter the mailing street address or P.O. Box for the business, including apartment, suite, or unit number if applicable.

Enter the state for the mailing address (use the standard two-letter abbreviation or full state name).

Enter the postal ZIP code for the mailing address (include ZIP+4 if available).

If the mailing address is in Florida, enter the county name; otherwise leave this field blank. Fill only if 'State' is 'Florida'.

Enter the country for the mailing address.

Enter the city name for the mailing address.

Enter the city name for your mailing address as it should appear on correspondence.

Enter the two-letter state or full state name for your mailing address.

Enter the ZIP code for your mailing address; include the +4 extension if desired.

Enter the full name of the country for your mailing address (e.g., United States).

Enter the full name of the county for the mailing address when the address is in Florida; leave this field blank if the mailing address is not in Florida. Fill only if 'Mailing State' is 'Florida'.

Enter your complete mailing street address or P.O. Box for correspondence, including apartment, suite, or unit number if applicable.

Check this box if you are a veteran with three years of military service and at least one year of experience as a foreman applicable to the category for which you are applying.

Check this box if you are a veteran with one year of military service, at least one year of foreman experience, and two years of experience as a worker or foreman applicable to the category for which you are applying.

Check this box if you are a veteran with two years of military service, at least one year of foreman experience, and one additional year of experience as a worker or foreman applicable to the category for which you are applying.

Check this box if Person 1 (Applicant) should answer "Yes" to Question 1 on the form.

Check this box if Person 1 (Applicant) should answer "Yes" to Question 2 on the form.

Check this box if Person 1 (Applicant) should answer "Yes" to Question 3 on the form.

Check this box if Person 1 (Applicant) should answer "No" to Question 1 on the form.

Check this box if Person 1 (Applicant) should answer "No" to Question 2 on the form.

Check this box if Person 1 (Applicant) should answer "No" to Question 3 on the form.

Check this box if Person 1 (Applicant) should answer "No" to Question 4 on the form.

Enter the applicant's full printed name for Person 1 as it should appear on official records.

Enter the Social Security Number for Person 1 (the applicant) as a continuous string of characters used to identify the individual.

Check this box if Person 1 (Applicant) should answer "Yes" to Question 4 on the form.

Enter the printed full name of Person 10's authorized representative.

Check this box if Person 10 answers "Yes" to Question 1.

Check this box if Person 10 answers "Yes" to Question 2.

Check this box if Person 10 answers "Yes" to Question 3.

Check this box if Person 10 answers "Yes" to Question 4.

Check this box if Person 10 answers "No" to Question 1.

Check this box if Person 10 answers "No" to Question 2.

Check this box if Person 10 answers "No" to Question 3.

Check this box if Person 10 answers "No" to Question 4.

Enter the Social Security number of Person 10's authorized representative as it should appear on the form (include dashes if applicable).

Enter the full printed name of Person 2's authorized representative as shown on official documents.

Check this box if the response to Question 1 for Person 2 (Authorized Representative) is Yes.

Check this box if the response to Question 2 for Person 2 (Authorized Representative) is Yes.

Check this box if the response to Question 3 for Person 2 (Authorized Representative) is Yes.

Check this box if the response to Question 4 for Person 2 (Authorized Representative) is Yes.

Check this box if the response to Question 1 for Person 2 (Authorized Representative) is No.

Check this box if the response to Question 2 for Person 2 (Authorized Representative) is No.

Check this box if the response to Question 3 for Person 2 (Authorized Representative) is No.

Check this box if the response to Question 4 for Person 2 (Authorized Representative) is No.

Enter Person 2's social security number exactly as issued, including any dashes if required by the form.

Enter the full printed name of Person 3’s authorized representative as shown on legal or identifying documents.

Check this box if Person 3 answers "Yes" to Question 1 in Section X — Background Questions.

Check this box if Person 3 answers "Yes" to Question 2 in Section X — Background Questions.

Check this box if Person 3 answers "Yes" to Question 3 in Section X — Background Questions.

Check this box if Person 3 answers "Yes" to Question 4 in Section X — Background Questions.

Check this box if Person 3 answers "No" to Question 1 in Section X — Background Questions.

Check this box if Person 3 answers "No" to Question 2 in Section X — Background Questions.

Check this box if Person 3 answers "No" to Question 3 in Section X — Background Questions.

Check this box if Person 3 answers "No" to Question 4 in Section X — Background Questions.

Enter the Social Security number for Person 3 (the authorized representative) exactly as it appears on their Social Security card or records.

Enter the printed full name of the authorized representative for Person 4.

Check this box if Person 4's answer to Question 1 is 'Yes'.

Check this box if Person 4's answer to Question 2 is 'Yes'.

Check this box if Person 4's answer to Question 3 is 'Yes'.

Check this box if Person 4's answer to Question 4 is 'Yes'.

Check this box if Person 4's answer to Question 1 is 'No'.

Check this box if Person 4's answer to Question 2 is 'No'.

Check this box if Person 4's answer to Question 3 is 'No'.

Check this box if Person 4's answer to Question 4 is 'No'.

Enter the Social Security number for Person 4 (include dashes or spaces if you normally record it that way).

Enter the full printed name of the authorized representative for Person 5.

Check this box if the answer to Question 1 for Person 5 is 'Yes'.

Check this box if the answer to Question 2 for Person 5 is 'Yes'.

Check this box if the answer to Question 3 for Person 5 is 'Yes'.

Check this box if the answer to Question 4 for Person 5 is 'Yes'.

Check this box if the answer to Question 1 for Person 5 is 'No'.

Check this box if the answer to Question 2 for Person 5 is 'No'.

Check this box if the answer to Question 3 for Person 5 is 'No'.

Check this box if the answer to Question 4 for Person 5 is 'No'.

Enter Person 5's Social Security number as a string (include all nine digits, with or without dashes as preferred).

Enter the printed full name of Person 6's authorized representative as it should appear on the form.

Check this box if Person 6's response to Question 1 is "Yes."

Check this box if Person 6's response to Question 2 is "Yes."

Check this box if Person 6's response to Question 3 is "Yes."

Check this box if Person 6's response to Question 4 is "Yes."

Check this box if Person 6's response to Question 1 is "No."

Check this box if Person 6's response to Question 2 is "No."

Check this box if Person 6's response to Question 3 is "No."

Check this box if Person 6's response to Question 4 is "No."

Enter the Social Security number for Person 6 (authorized representative) as a text string, including any dashes if required by the form.

Enter the full printed name of Person 7's authorized representative as it should appear on the form.

Check this box if Person 7's answer to Question 1 is "Yes."

Check this box if Person 7's answer to Question 2 is "Yes."

Check this box if Person 7's answer to Question 3 is "Yes."

Check this box if Person 7's answer to Question 4 is "Yes."

Check this box if Person 7's answer to Question 1 is "No."

Check this box if Person 7's answer to Question 2 is "No."

Check this box if Person 7's answer to Question 3 is "No."

Check this box if Person 7's answer to Question 4 is "No."

Enter the Social Security number for Person 7 (include any dashes if required by the form).

Check this box if Person 8 answered "Yes" to Question 1.

Check this box if Person 8 answered "Yes" to Question 2.

Check this box if Person 8 answered "Yes" to Question 3.

Check this box if Person 8 answered "Yes" to Question 4.

Check this box if Person 8 answered "No" to Question 1.

Check this box if Person 8 answered "No" to Question 2.

Check this box if Person 8 answered "No" to Question 3.

Check this box if Person 8 answered "No" to Question 4.

Enter the printed full name of Person 8's authorized representative as shown on their legal documents.

Enter Person 8's Social Security number as a continuous string of digits (do not include spaces or dashes unless the form requests them).

Check this box if Person 9's answer to Question 1 is 'Yes'.

Check this box if Person 9's answer to Question 2 is 'Yes'.

Check this box if Person 9's answer to Question 3 is 'Yes'.

Check this box if Person 9's answer to Question 4 is 'Yes'.

Check this box if Person 9's answer to Question 1 is 'No'.

Check this box if Person 9's answer to Question 2 is 'No'.

Check this box if Person 9's answer to Question 3 is 'No'.

Check this box if Person 9's answer to Question 4 is 'No'.

Enter the full printed name of Person 9's authorized representative exactly as it should appear on the form.

Enter Person 9's Social Security number using the digits for the SSN.

Enter the full legal name of the person appointed as the primary qualifier for the business organization.

Enter the license number of the primary qualifying agent, if they hold a professional or contractor license (leave blank if not applicable).

Check this box if you have used, been known as, or are currently known by any other name (maiden name, pseudonym, nickname, alias, or any name other than the name signed on this application).

Check this box if you have never used and are not known by any name other than the name signed on this application.

Enter the full official name or title of the project as shown on contracts or plans.

Enter the project's full street address including city, state and ZIP code.

Check this box when the project being reported is a renovation.

Check this box when the project being reported is new construction.

Enter the job title you held on this project (for example: Project Manager, Superintendent, Foreman).

Provide a short summary of your primary duties and responsibilities on the project.

Provide a detailed description of the work you performed, including tasks, scope of responsibility, methods used and any notable activities.

List project-specific details such as number of stories, total square footage, major materials used, and other quantifiable or distinguishing characteristics.

Enter the official name or title of the project as it appears on contracts or project documents. Fill only if 'Foundation/Slabs greater than 20,000 sq. ft.', 'Column erection', 'Masonry walls', 'Formwork for structural reinforced concrete', 'Elevated slabs', 'Steel erection' is 'Yes' (any).

Enter the full street address (including city and state) where the project was located. Fill only if 'Foundation/Slabs greater than 20,000 sq. ft.', 'Column erection', 'Masonry walls', 'Formwork for structural reinforced concrete', 'Elevated slabs', 'Steel erection' is 'Yes' (any).

Check this box if the project was new construction (not a renovation or remodel). Fill only if 'Foundation/Slabs greater than 20,000 sq. ft.', 'Column erection', 'Masonry walls', 'Formwork for structural reinforced concrete', 'Elevated slabs', 'Steel erection' is 'Yes' (any).

Check this box if the project was a renovation, remodel, or alteration of an existing structure. Fill only if 'Foundation/Slabs greater than 20,000 sq. ft.', 'Column erection', 'Masonry walls', 'Formwork for structural reinforced concrete', 'Elevated slabs', 'Steel erection' is 'Yes' (any).

Enter detailed information about the project such as number of stories, total square footage, materials used, and any other relevant construction specifics. Fill only if 'Foundation/Slabs greater than 20,000 sq. ft.', 'Column erection', 'Masonry walls', 'Formwork for structural reinforced concrete', 'Elevated slabs', 'Steel erection' is 'Yes' (any).

Enter the full license number of the qualifying contractor exactly as issued by the licensing authority. Fill only if 'Qualifying Contractor Name' is filled.

Enter the full legal name of the qualifying contractor for the employer.

Enter the full name of the qualifying contractor's contact person (first and last name). Fill only if 'Qualifying Contractor Name' is filled.

Enter the email address for the qualifying contractor's contact person. Fill only if 'Qualifying Contractor Name' is filled.

Enter the two-letter U.S. state or region name for your residence address.

Enter the ZIP Code for your residence address (include the +4 extension if applicable).

Enter the name of the city where you currently reside for your residence address.

Enter the county of your residence only if your residence address is in Florida; otherwise leave this field blank. Fill only if 'Residence State' is 'Florida'.

Enter the country name for your residence address (the country where you currently live).

Enter the primary residence street address (if different than mailing address), including house number and street name (and apartment or unit number if it fits on this line).

Enter any additional address information for the residence such as apartment, unit, suite, building, or other secondary address details.

Enter the project's start and end dates covering the period when the work was performed.

Check this box if your role on the listed project was a Foreman (not a Worker).

Check this box if your role on the listed project was a Worker (not a Foreman).

Enter the number identifying which person this explanation relates to (e.g., 1, 2, 3, 4, 5 or another specified number).

Check this box if the explanation on this Second Explanation block relates to person #1.

Check this box if the explanation on this Second Explanation block relates to person #2.

Check this box if the explanation on this Second Explanation block relates to person #3.

Check this box if the explanation on this Second Explanation block relates to person #4.

Check this box if the explanation on this Second Explanation block relates to person #5.

Check this box if the explanation on this Second Explanation block relates to person #6.

Check this box if the explanation on this Second Explanation block pertains to question #3.

Check this box if the explanation on this Second Explanation block pertains to question #4.

Enter the state or jurisdiction associated with the matter described in this explanation.

Enter the application type and/or license number that applies to the explanation (include both if applicable). Fill only if 'Second Explanation — Question #3', 'Second Explanation — Question #4' is 'Yes' any.

Provide the detailed written explanation describing the circumstances, facts, relevant dates, and any other information necessary to clarify the 'Yes' answer referenced. Fill only if 'First Explanation - Person #5', 'First Explanation - Person #8', 'Second Explanation - Person Number', 'Second Explanation — Person #1', 'Second Explanation — Person #2', 'Second Explanation — Person #3', 'Second Explanation — Person #4', 'Second Explanation — Person #5' is 'Yes' any.

Enter the last name the applicant has used or been known by for the second prior name (e.g., maiden or former surname). Fill only if 'Prior Name - Yes' is 'Yes'.

Enter the first (given) name the applicant used for the second prior name. Fill only if 'Prior Name - Yes' is 'Yes'.

Enter the middle name or initial the applicant used for the second prior name. Fill only if 'Prior Name - Yes' is 'Yes'.

Enter any title or prefix used with this prior name (for example Dr., Mr., Ms.). Fill only if 'Prior Name - Yes' is 'Yes'.

Enter any suffix used with this prior name (for example Jr., Sr., III). Fill only if 'Prior Name - Yes' is 'Yes'.

Enter the full name of the second qualifier (the person who qualifies the business) as it should appear on official records. Fill only if 'Business Already Qualified — Yes' is 'Yes'.

Enter the official license or registration number under which the second qualifier is qualified to represent the business. Fill only if 'Business Already Qualified — Yes' is 'Yes'.

Enter the full name of the person legally appointed as the secondary qualifying agent who will be responsible for supervising fieldwork at sites where their license was used.

Enter the license number of the secondary qualifying agent, if they hold a license; leave blank if not applicable.

Enter the applicant's handwritten or typed signature to affirm and certify the information in this written declaration.

Enter the date on which the applicant signed this written declaration.

Enter the applicant's full printed (legible) name as it should appear alongside the signature.

Enter your full nine-digit U.S. Social Security Number (include any leading zeros), using digits only — do not include dashes or spaces.

Check this box if the experience described was in the construction of structures four stories or higher (i.e., affirming 'Yes').

Check this box if the experience described was not in the construction of structures four stories or higher (i.e., affirming 'No').

Check this box when the applicant's submitted credit report does not show a FICO-derived credit score of 660 or higher.

Check this box when the applicant's submitted credit report shows a FICO-derived credit score of 660 or higher.

Enter the date when the third license or registration first became effective.

Enter the date when the third license or registration first became effective.

Enter the date when the third license or registration first became effective.

Enter the date when the third license or registration ended or was last active.

Enter the date when the third license or registration ended or was last active.

Enter the type or category of the third license or registration (for example, professional, contractor, business).

Enter the U.S. state or other jurisdiction that issued the third license or registration.

Enter the date when the third license or registration ended or was last active.

Enter the license or registration number exactly as issued for the third license/registration.

Enter the name that was used on that third license or registration if it differs from your current legal name.

Enter the last (family) name you used or were known by for the third prior name. Fill only if 'Prior Name - Yes' is 'Yes'.

Enter the first (given) name you used or were known by for the third prior name. Fill only if 'Prior Name - Yes' is 'Yes'.

Enter the middle name or middle initial you used or were known by for the third prior name. Fill only if 'Prior Name - Yes' is 'Yes'.

Enter any title associated with that prior name (for example: Dr., Mr., Ms., Esq.). Fill only if 'Prior Name - Yes' is 'Yes'.

Enter any suffix associated with that prior name (for example: Jr., Sr., II, III). Fill only if 'Prior Name - Yes' is 'Yes'.

Enter the full name of the third individual who qualifies the business (first and last name or legal business qualifier name). Fill only if 'Business Already Qualified — Yes' is 'Yes'.

Enter the license or registration number under which the third qualifier is licensed to qualify the business (include letters or dashes if part of the official number). Fill only if 'Business Already Qualified — Yes' is 'Yes'.

Enter the total number of years of work experience from your Employment History in Part B that apply to the Worker role. Fill only if '1 Worker' is 'Yes'.

Enter the total number of years of work experience from your Employment History in Part B that apply to the Foreman role. Fill only if '2 Foreman' is 'Yes'.

Check this box when the total time of experience you entered in Part B represents your experience working as a worker and you are claiming those years toward your qualification.

Check this box when the total time of experience you entered in Part B represents your experience working as a foreman and you are claiming those years toward your qualification.