Fill - Free fillable MASTER/JOURNEYMAN EXAMINATION APPLICATION AND FEES (Brevard County Board of Commissioners) PDF form

Licensing Regulation & Enforcement

2725 Judge Fran Jamieson Way, Bldg. A-114

Viera, Florida 32940

Phone: (321) 633-2058, press 4, 6

contractorlicensing@BrevardFL.gov

MASTER/JOURNEYMAN EXAMINATION APPLICATION AND FEES

APPLICATION FEES ARE NON-REFUNDABLE

Trade Category Application Fees:

JOURNEYMAN $65 MASTER $110

AIR CONDITIONING ELECTRICIAN

ELECTRICIAN PLUMBER

PLUMBER

ROOFER

SHEETMETAL

The following documents must be submitted with application:

 Application fee as indicated above

o Make checks payable to Brevard County BOCC

 Copy of driver’s license

 Notarized documentation of experience on attached Experience Form

 Signed Social Security Number Disclaimer

DO NOT WRITE IN THIS SPACE

DATE CAP ID PYMT TYPE INVOICE # STAFF

Master/Journeyman Examination Application

Date ___________________ Trade Category ___________________________________________

Select one: Master Journeyman Application Fee $______________________

1. Name (last, first, MI) _____________________________________________________________

2. Address _______________________________________________________________________

3. Date of Birth ________________________ Email ______________________________________

4. Phone # ___________________ Daytime Phone # __________________ Fax # _____________

5. U S Citizen? Yes No

6. Height: _________ Weight __________ Eye Color:____________ Hair Color:____________

EMPLOYMENT / EDUCATION INFORMATION – TO BE COMPLETED BY THE APPLICANT

Present Employer ___________________________________ Phone # _______________________

Address _________________________________________________________________________

Position Held ___________________________________ Length of employment ________________

Name and Address of Previous Employer

________________________________________________________________________________

Dates of Employment ______________________________ Position _________________________

Name and Address of Previous Employer

________________________________________________________________________________

Dates of Employment ______________________________ Position _________________________

Name and Address of Previous Employer

________________________________________________________________________________

Dates of Employment ______________________________ Position _________________________

Total years as Helper ___________ Total years as licensed Journeyman ___________

Master/Journeyman Application for Exam

SCHOOLING – Provide copies of certificates/diplomas/transcripts

High School __________________________________________ # Years Attended _____________

College ______________________________________________ # Years Attended _____________

Apprenticeship School __________________________________ # Years Attended _____________

I certify that this information is true and correct to the best of my knowledge and that any willful

falsification of any information contained herein is grounds for disqualification.

Signature of Applicant __________________________________ Date _____________________

STATE OF _____________________

COUNTY OF _____________________

The foregoing instrument was acknowledged before me this ______ day of ________________,

20______, by _____________________________________ who is personally known to me _____

or who produced a ________________________________________ as identification.

(Notary Seal)

_________________________________

Signature of Notary

Experience Requirements

ALL JOURNEYMAN APPLICANTS shall provide evidence of four years’ experience in the trade;

however, the Contractors’ Licensing Board may reduce said requirement to two years for individuals

who show proof of formal education in the applicable trade. An individual who has completed four

years (2000 hours OJT per year) of apprenticeship training in the trade and furnishes a certificate as

proof of training are considered to have the required experience.

ALL MASTER APPLICANTS shall provide evidence of five years of practical experience in the trade,

of which a minimum of three years can be as a journeyman. The Contractors’ Licensing Board may

consider a person’s formal vocational education as practical experience in the trade.

MASTERS ARE NOT CONTRACTORS, CANNOT PULL PERMITS OR OPERATE A BUSINESS

EXPERIENCE MUST BE DOCUMENTED IN WRITING BY YOUR EMPLOYER(S) (PAST OR

PRESENT) FOR PROOF OF EXPERIENCE, see attached. More than one experience form may

be used or original letters on business letterhead or original notarized letters. The letters

must be specific to the type of work that was done and must document the dates of

employment. All documents must be originals.

If Experience Documentation is not completed by a certified contractor, the documentation

may be completed by authorized personnel who has or had job related direct contact with

applicant, i.e., job superintendent or supervisor.

SOCIAL SECURITY NUMBER DISCLAIMER

** "Under the Federal Privacy Act, disclosure of Social Security numbers is voluntary unless

specifically required by Federal statute. In this instance, Social Security numbers are mandatory

pursuant to Title 42 United States Code, Sections 653 and 654; and Sections 455.203(9); 409,2577,

and 409.2598, Florida Statutes. Social Security numbers are used to allow efficient screening of

applicants and licensees by a Title IV-D child support agency to assure compliance with child support

obligations. Social Security numbers must also be recorded on all professional and occupations

license applications and will be used for licensee identification pursuant to the Personal Responsibility

and Work Opportunity Reconciliation Act of 1996 (Welform Reform Act), 104 Pub.L. 193, Sec.317."

You must print your name, Social Security Number, date and sign that you have read the disclaimer

above:

________________________ ________________________

(Print Name) (Social Security Number)

__________________________________ Date ___________________

(Sign)

Please cut along dotted line and keep bottom portion of the disclaimer for your records

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