Fillable Require App For Contractor RME 11.17R (Hawaii)

Fill Online, Printable, Fillable, Blank Require App For Contractor RME 11.17R (Hawaii) Form

Use Fill to complete blank online HAWAII (US) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Require App For Contractor RME 11.17R (Hawaii)

On average this form takes 99 minutes to complete

The Require App For Contractor RME 11.17R (Hawaii) form is 35 pages long and contains:

  • 0 signatures
  • 71 check-boxes
  • 363 other fields

Country of origin: US
File type: PDF

BROWSE HAWAII (US) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
(CONTINUED ON PAGE 2)
REQUIREMENTS FOR LICENSE - CONTRACTOR
Access this form via website at: cca.hawaii.gov/pvl
RESPONSIBLE MANAGING EMPLOYEE
Briefly, the requirements for a license are:
1) Be not less than 18 years of age;
2) Have a good reputation for honesty, truthfulness, financial integrity and fair dealing;
3) Have 4 years of supervisory experience within the past 10 years;
4) Pass an examination in the appropriate classification; and
5) Be employed by a licensed contracting entity.
This is the general licensure process and what you may expect after filing an application:
1) Applicant files application, fee and other required items on or before the first Tuesday of the month.
2) Board reviews complete applications the following month.
3) Board notifies applicant of approval/disapproval/deferral.
4) Approved applicant registers with a separate testing agency for exam and pays testing agency exam fees.
5) Applicant takes exam the following month.
6) Upon passing the exam, Board notifies applicant of license requirements.
7) Applicant submits license requirements.
8) Board issues license to applicant.
9) Maintain license.
APPLICATION FILING DEADLINE
Application, fee and all supporting documents to be presented to the Board must be received in the Board's Honolulu office on or
before the first Tuesday of the month prior to the scheduled meeting date. The Board is scheduled to meet once a month, except
for the month of December. Refer to the schedule for all dates at: cca.hawaii.gov/pvl/boards/contractor/meeting_schedule.
Each application must be submitted with the following items for consideration by the Board: FAXED or EMAILED COPIES WILL NOT BE
ACCEPTED.
1. Application fee;
2. Experience certificates;
3. Chronological History of Projects Form ("Project List");
4. Credit report; and
5. Entity appointment.
INSTRUCTIONS FOR FILING
APPLICATION Complete all pages of the application.
Failure to provide all the requested information will delay the processing of your application.
CT-00(A) 1117R
RELEASE OF
INFORMATION
If an agency or individual is assisting you with the licensure process, we will not be able to release any information
to them unless you provide us with authorization. If you wish to do so, please complete the portion on Release of
Information to Third Party, sign and date it.
SOCIAL
SECURITY
NUMBER
Your Social Security Number is used to verify your identity for licensing purposes and for compliance with the below
laws. For a license to be issued you must provide your Social Security Number or your application will be
deemed deficient and will not be processed further.
-2-
(CONTINUED ON PAGE 3)
(cont'd)
SOCIAL
SECURITY
NUMBER
The following laws require that you furnish your Social Security Number to our agency:
FEDERAL LAWS:
42 U.S.C.A. §666(a)(13) requires the Social Security Number of any applicant for a professional license or
occupational license be recorded on the application for license; and
if you are a licensed health care practitioner, 45 C.F.R., Part 61, Subpart B, §61.7 requires the Social Security
Number as part of the mandatory reporting we must do to the Healthcare Integrity and Protection Data Bank
(HIPDB), of any final adverse licensing action against a licensed health care practitioner.
HAWAII REVISED STATUTES ("HRS"):
§576D-13(j), HRS requires the Social Security Number of any applicant for a professional license or occupational
license be recorded on the application for license; and
§436B-10(4), HRS which states that an applicant for license shall provide the applicant's Social Security Number if
the licensing authority is authorized by federal law to require the disclosure (and by the federal cites shown above,
we are authorized to require the Social Security Number).
FEES Attach the $50 non-refundable application fee for each application filed. Additional fees will be assessed after
Board approval and passage of the examination. Make checks payable to: "COMMERCE AND CONSUMER AFFAIRS".
(check must be in U.S. dollars and be from a U.S. financial institution.)
NOTE: One of the numerous legal requirements that you must meet in order for your new license to be issued is the
payment of fees as set forth in this application. You may be sent a license certificate before the payment you sent us for
your required fees is honored by your bank. If your payment is dishonored, you will have failed to pay the required
licensing fee and your license will not be valid, and you may not do business under that license. Also, a $25.00 service
charge shall be assessed for payments that are dishonored for any reason.
If for any reason you are denied the license you are applying for, you may be entitled to a hearing as provided by Title 16,
Chapter 201, Hawaii Administrative Rules, and/or Chapter 91, Hawaii Revised Statutes. Your written request for a
hearing must be directed to the agency that denied your application, and must be made within 60 days of notification
that your application for a license has been denied.
EXPERIENCE A minimum of 4 years of supervisory experience within the past 10 years immediately preceding the filing of an
application is required.
Submit not less than 3 notarized certificates in support of supervisory experience with application. If applying for
more than one classification, submit at least one experience certificate for each classification. (No two certificates in
the same classification shall be from the same person.) Inform the person completing your experience certificate that
they must describe in detail your experience performing on-site supervision and direction of employees in the
classification you are applying for.
Submit a Project List as documentation of the applicant's previous supervisory work experience. Use as many pages
as necessary to verify your four (4) years of supervisory experience. The Project List may be duplicated and is
available on the Contractor License Board's website at:
http://cca.hawaii.gov/pvl/boards/contractor/application_publication. Click on "Chronological History of
Projects Form".
Submit a separate Project List for each classification the applicant intends to engage. Only include work experience
performing on-site supervision and direction of employees.
Please ensure that the Project List is filled out completely (provide information in each column of the form) and that
it includes the following:
•
•
•
A description of your supervisory work experience performed in-house, with your own crew; and work or trades
that were subcontracted to other contractors; and the means and methods of each project listed.
The "Contract Amount" stated should be commensurate with information stated in the "Detailed Description of
the Work You Supervised".
The "Amount of Supervisory Experience" should only include the actual amount of time spent on-site
supervising your own crew. Do not include time spent for design, ordering materials, scheduling of downtime
for rain-outs or waiting for delivery of materials.
EXPERIENCE
CERTIFICATES
CHRONOLOGICAL
HISTORY OF
PROJECTS FORM
("PROJECT LIST")
-3-
(CONTINUED ON PAGE 4)
CREDIT REPORT
Submit a current and complete credit report for each officer, partner, manager, or member, (from a credit reporting
agency issued not more than 6 months ago) covering at least the previous 5 years. If a partner or member is a
business entity, submit credit reports on the entity's officers or the business entity's credit report (i.e. Comprehensive
Dun & Bradstreet report) covering at least the previous 5 years.
A complete credit report must contain, at minimum, detailed account information on each of your current and past
debts, the status of those debts, whether you are current or delinquent in paying any of those debts, and the
existence or not of any public records. A credit report that only provides a summary or a credit score is not a
complete credit report. For more information on credit reports, please go to the Federal Trade Commission's website
at: https://www.consumer.ftc.gov/articles/0155-free-credit-reports or go to
www.ftc.gov and enter "credit report" in the search box.
ASBESTOS CONTRACTOR
RMEs applying to do asbestos application, enclosure, removal, encapsulation, renovation, repair, demolition or other
disturbances of friable asbestos or asbestos containing material shall meet all requirements with the exception of
experience.
In lieu of experience, the RME shall submit proof of successful completion of a 4-day Environmental Protection
Agency (EPA) or Board approved asbestos training course within two years prior to filing the application.
Applicants who possess licensed experience in another state should provide proof of licensure, but will still be
required to submit not less than 3 certificates in support of supervisory experience and the Project List.
Certain technical training may be approved as acceptable experience, but in no case shall the training count for more
than one year of experience.
CHRONOLOGICAL
HISTORY OF
PROJECTS FORM
("PROJECT LIST")
cont'd
Contracting Entity not licensed in Hawaii:
Contracting entity must submit a Contractor Entity application.
Contracting Entity licensed in Hawaii:
Submit a letter confirming RME employment. IF the RME will be the RME for more than one contracting entity ("dual"
status), submit documentation verifying one of the following requirements:
1) Common ownership if at least fifty-one percent of each contracting entity (Documentation of ownership includes,
but is not limited to, tax returns (Schedule C or Form 1065 for LLCs, Schedule K-1 or Form 1125E for Corporations);
Stock Certificates; Business Registration documents (for single member LLC's only); or Operating agreement.)
2) A contracting entity is a subsidiary or joint venture with the other contracting entity;
3) Direct immediate family relationship between the RME and the officers, directors, members, managers or partners
of the other contracting entity; or
4) Direct immediate family relationship between the officers, directors, members, managers and partners of all
contracting entities for which the individual acts as the RME.
RME/ENTITY
APPOINTMENT
LAWS & RULES A copy of the Contractors laws and rules may be obtained by submitting a written request to: Contractors License
Board, DCCA, P.O. Box 3469, Honolulu, Hawaii 96801. Chapter 436B, Hawaii Revised Statutes, the Professional and
Vocational Licensing Act should be read in conjunction with the above Statutes.
The laws and rules are also available on our website at: cca.hawaii.gov/pvl. Click on "Contractors". Then click on
"Statute/Rule Chapter" on the right.
Mail the completed application, proper fee amount and other required documents to:BOARD'S ADDRESS
Contractors License Board
DCCA, PVL Licensing Branch
P.O. Box 3469
Honolulu, HI 96801
OR
Deliver to office location at:
335 Merchant St., Room 301
Honolulu, HI 96813
Phone: (808) 586-3000
-4-
(CONTINUED ON PAGE 5)
ABANDONMENT
OF APPLICATION
Pursuant to HRS §436B-9 your application shall be considered abandoned and shall be destroyed if you fail to
provide evidence of continued efforts to complete the licensing process for two consecutive years. The failure to
provide evidence of continued efforts include but is not limited to: (1) failure to submit any required information and
documents requested by the licensing authority within two consecutive years from the last date the documents and
information were requested, or (2) failure to complete any additional requirements for licensure that remain after
approval of your application, such as attempting to complete an exam requirement, within two consecutive years
from the date your application was approved, or (3) failure to provide the licensing authority with any written
communication during two consecutive years indicating that you are attempting to complete the licensing process.
If an application is deemed abandoned the applicant shall be required to reapply for licensure and comply with the
licensing requirements in effect at the time of the reapplication.
EXAMINATION
The contractors licensing examinations are administered by a professional testing service, Prometric.
Applicants, upon approval by the Board, will be provided with examination registration forms. Applicants must mail the registration forms,
together with the appropriate examination fees, directly to Prometric. Phone: (808) 261-8182.
EXAMINATION DATES AND REGISTRATION DEADLINES ARE AVAILABLE ON THE CONTRACTOR'S WEBPAGE.
Applicant must pass a written examination covering the following:
PART I Business and law (A copy of the Contractors laws and rules may be obtained by submitting a written request to the:
Contractors License Board, DCCA, P.O. Box 3469, Honolulu, HI 96801).
The laws and rules are also available on our website at: cca.hawaii.gov/pvl. Click on "Contractors".
NOTE: It is strongly suggested that applicants obtain a copy of the contractor's licensing law and rules.
PART II Trade (field knowledge in classification requested).
Recommended Study materials for the Part II examination may be obtained by calling Prometric at: (808) 261-8182. Some
books are available at public libraries. Refer to the listing in the "Bulletin of Examination Information".
Questions regarding the examination, study material, or sitting for the exam in another state should be directed to the
testing agency, Prometric. Phone: (808) 261-8182 or visit their website at: www.prometric.com/hawaii.
REQUESTS TO TAKE THE LICENSING EXAMINATION OUT-OF-STATE - Must be approved by the Board. Submit your written request along
with your application in advance of the deadline date, to allow for sufficient processing time. Please be advised that you are responsible for any
additional cost for this out-of-state testing accommodation and test locations are limited to sites at which the testing service has a secured
office.
REQUESTS TO USE AN INTERPRETER - Must be approved by the Board. Form is available from website at: cca.hawaii.gov/pvl or contact
Prometric at: (808) 261-8182. The fee for this service is $100, added to your examination fee.
-5-
(CONTINUED ON PAGE 6)
LICENSE REQUIREMENTS
(Upon Passing the Exam)
FEES License fees will be due. Specific amounts will be given at the appropriate time.
ATTENTION: CONTRACTORS APPLYING FOR ELECTRICAL OR PLUMBING RELATED CLASSIFICATIONS
Please be advised that in order to perform electrical or plumbing work in Hawaii, an individual must also obtain an electrician (i.e. ES or EJ)
or plumber (PM or PJ) license. IF you are not licensed as an electrician or plumber in accordance with HRS Chapter 448E, the contractor entity
(your employer) must employ a licensed electrician or plumber to actually perform the electrical or plumbing work. (Refer to Hawaii Revised
Statutes, Section 444-9.5 and Chapter 448E). YOU MAY NEED THIS TYPE OF LICENSE TO GET A BUILDING PERMIT.
MAINTAINING THE LICENSE
MAINTAIN
INSURANCE
Contracting entities must maintain continuous insurance coverage throughout licensure and keep on file in the
Board's office evidence of such coverage.
Failure to maintain continuous liability and workers' compensation coverages causes automatic forfeiture of the
contracting entity and RME license, and if continuous coverage is not reinstated within sixty (60) days, shall
require the entity and RME to apply as a new applicant.
ENTITY-RME
DEPENDENCY
RMEs who leave an entity shall notify the Board within sixty (60) days and apply to become a contracting entity,
obtain employment with another contracting entity or file an application to place the license on an inactive status
within ninety (90) days. Failure to do so within the required time period will cause automatic forfeiture of the
license.
BIENNIAL
RENEWAL
All licenses, regardless of issuance date, are subject to renewal by September 30 of each even-numbered year. To
ensure receipt of a renewal application, keep the Board informed of your address. (RME renewal applications will be
sent to the entity's address.) Applications are sent by mail before August 15, of each even-numbered year. Licenses
not renewed by September 30 are forfeited and the holders of a forfeited license are considered unlicensed and may
not practice. Restorations of forfeited licenses are accepted until November 30 of the even-numbered year with a
penalty fee. After November 30, restoration is not accepted and a new application for a license is required.
Please inform your insurance agent that using the Insurance Certificate Electronic Online Submittal System at:
pvl.ehawaii.gov/inikua provides faster processing of your contractor insurance certificates.
CLASSIFICATIONS AS LISTED IN CHAPTER 77
HAWAII ADMINISTRATIVE RULES
"A" General Engineering
"B" General Building
C-1 Acoustical and insulation contractor;
C-2 Mechanical insulation contractor;
C-3 Asphalt paving and surfacing contractor;
C-3a Asphalt concrete patching, sealing, and striping contractor;
C-3b Play court surfacing contractor;
C-4 Boiler, hot-water heating, and steam fitting contractor;
C-5 Cabinet, millwork, and carpentry remodeling and repairs contractor;
C-5a Garage door and window shutters contractor;
C-5b Siding application contractor;
C-6 Carpentry framing contractor;
C-7 Carpet laying contractor;
C-9 Cesspool contractor;
C-10 Scaffolding contractor;
C-12 Drywall contractor;
C-13 Electrical contractor;
C-14 Sign contractor;
C-15 Electronic systems contractor;
C-15a Fire and burglar alarm contractor;
C-15b Telecommunications contractor;
C-16 Elevator contractor;
C-16a Conveyor systems contractor;
C-17 Excavating, grading, and trenching contractor;
C-19 Asbestos contractor;
C-20 Fire protection contractor;
C-20a Fire repressant systems contractor;
C-21 Flooring contractor;
C-22 Glazing and tinting contractor;
C-22a Glass tinting contractor;
C-23 Gunite contractor;
C-24 Building moving and wrecking contractor;
C-25 Institutional and commercial equipment contractor;
C-27 Landscaping contractor;
C-27a Hydro mulching contractor;
C-27b Tree trimming and removal contractor;
C-31 Masonry contractor;
C-31a Cement concrete contractor;
C-31b Stone masonry contractor;
C-31c Refractory contractor;
C-31d Tuckpointing and caulking contractor;
C-31e Concrete cutting, drilling, sawing, coring, and pressure grouting contractor;
C-32 Ornamental, guardrail, and fencing contractor;
C-32a Wood and vinyl fencing contractor;
C-33 Painting and decorating contractor;
C-33a Wall coverings contractor;
C-33b Taping contractor;
C-33c Surface treatment contractor;
C-34 Soil stabilization contractor;
(CONTINUED ON PAGE 7)
-6-
More information on the following classifications may be found at: cca.hawaii.gov/pvl/boards/contractor. Click on the link "Description of
Contractor License Classifications".
C-35 Pile driving, pile and caisson drilling, and foundation contractor;
C-36 Plastering contractor;
C-36a Lathing contractor;
C-37 Plumbing contractor;
C-37a Sewer and drain line contractor;
C-37b Irrigation and lawn sprinkler systems contractor;
C-37c Vacuum and air systems contractor;
C-37d Water chlorination and sanitation contractor;
C-37e Treatment and pumping facilities contractor;
C-37f Fuel dispensing contractor;
C-38 Post tensioning contractor;
C-40 Refrigeration contractor;
C-40a Prefabricated refrigerator panels contractor;
C-41 Reinforcing steel contractor;
C-42 Roofing contractor;
C-42a Aluminum and other metal shingles contractor;
C-42b Wood shingles and wood shakes contractor;
C-42c Concrete and clay tile contractor;
C-42e Urethane foam contractor;
C-42g Roof coatings contractor;
C-43 Sewer, sewage disposal, drain, and pipe laying contractor;
C-43a Reconditioning and repairing pipeline contractor;
C-44 Sheet metal contractor;
C-44a Gutters contractor;
C-44b Awnings and patio cover contractor;
C-48 Structural steel contractor;
C-48a Steel door contractor;
C-49 Swimming pool contractor;
C-49a Swimming pool service contractor;
C-49b Hot tub and pool contractor;
C-51 Tile contractor;
C-51a Cultured marble contractor;
C-51b Terrazo contractor;
C-52 Ventilating and air conditioning contractor;
C-53 Miscellaneous retail products;
C-54 Interior design;
C-55 Waterproofing contractor;
C-56 Welding contractor;
C-57 Well contractor;
C-57a Pumps installation contractor;
C-57b Injection well contractor;
C-60 Solar power systems contractor;
C-61 Solar energy systems contractor;
C-61a Solar hot water systems contractor;
C-61b Solar heating and cooling systems contractor;
C-62 Pole and line contractor;
C-62a Pole contractor,
C-63 High voltage electrical contractor; and
C-68 Classified specialist.
-7-
This material can be made available for individuals with special needs. Please call the Licensing Branch Manager at (808) 586-3000 to submit your request.
Print Form
APPLICATION FOR CONTRACTOR'S LICENSE -
RESPONSIBLE MANAGING EMPLOYEE
Access this form via website at: cca.hawaii.gov/pvl
State of Hawaii
Dept. of Commerce and Consumer Affairs
CONTRACTORS LICENSE BOARD
335 Merchant St., Room 301, PO Box 3469
Honolulu, HI 96801
INSTRUCTIONS - To avoid delay read all instructions carefully.
Each applicable question must be fully and truthfully answered. Any material
misrepresentation is grounds for refusal or subsequent revocation of license.
Attach sheets to this application when so instructed or where the space provided
for the answer is not sufficient.
Answer all questions. No license will be considered until this application is
completed. If a question is not applicable, indicate with "NA".
Applications must be printed legibly in black ink or typewritten with the fillable
form.
The required $50.00 application fee must be attached and submitted with this
application form. Make check payable to: "Commerce and Consumer Affairs".
(check must be in U.S. dollars and be from a U.S. financial institution.)
FOR BOARD USE ONLY
License No. Effective Date:
CT -
CLASS(ES):
A.
B.
C.
Name of Applicant (First, Middle, Last):
Name of Contracting Entity you are applying to be the RME for:
Social Security No.: Phone No. (days):
D.
•
Mailing Address:
•
License No.:
OR
Residence Address:
E.
F.
Set forth in detail the kind of contracting business in which the applicant intends to engage:
Classification(s) requested ( )
Name of classificationSymbol - see list
G. EDUCATION: Vocational School, College, University, Special Training: MonthsYears
H.
STATE LICENSES
Name of State License No. Date Issued Classifications FOR OFFICE USE ONLY
Credit Report
Experience
Entity Appointment
Attach copy of each contractor's license previously held in any state.
CT-35 1116R
Appl . . . . . . . . . . . . . . . 115. . . . . . . $ 50 Lic . . . . . . . . . . . . . . . . . 116. . . . . . . $260
CRF . . . . . . . . . . . . . . . . 117. . . . . . . $ 74/$148
1/2 Ren . . . . . . . . . . . . 100. . . . . . . $ 30
Service Charge . . . . . BCF. . . . . . $ 25
RME:
(CONTINUED ON PAGE 2)
This material can be made available for individuals with
special needs. Please call the Licensing Branch
Manager at (808) 586-3000 to submit your request.
Date applied for license:
(Street address, City, State and Zip Code)
(P.O. Box or Street address, City, State and Zip Code)
Print Applicant Name: Date:
(LAST, First, Middle)
EACH QUESTION MUST BE ANSWERED
I.
Are you at least 18 years of age? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YES NO1.
2.
3.
4.
5.
6.
Are you a U.S. citizen, a U.S. national, or an alien authorized to work in the United States? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Have you previously applied for a Hawaii State contractor's license? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
YES NO
YES NO
Have you ever been affiliated with a contracting entity whose license has been terminated due to issuance of a
court order authorizing payment from the Contractors Recovery Fund of this state or any other state? . . . . . . . . . . . . . . . .
Have you or any construction organization in which you were an officer, partner, manager or member had a
contractor's license or any professional or vocational license denied, fined, suspended or revoked by this state
or any other state? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(If "Yes", state month and year:
YES NO
YES NO
YES NO
(If "Yes", submit a detailed statement giving the date of the order and circumstances leading up to
issuance of the court order.)
(For the purpose of this question, "denied" does not mean that one has previously failed an examination.)
(If "Yes", attach a detailed statement signed by you.)
Has any bonding or surety company ever completed or made a financial settlement upon any construction
contract or work undertaken by you or any construction organization in which you were an officer,
partner, manager or member? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(If "Yes", attach a detailed statement signed by you.)
7. Are there now any unpaid past due bills or claims for labor, materials, or services, outstanding and
unsatisfied, as a result of your operations or of any construction organization in which you were an
officer, partner, manager or member? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
YES NO
(If "Yes", attach a detailed statement signed by you.)
Are there now any liens, suits, or judgments of record or pending, outstanding and unsatisfied, as a result of your
operations or of any construction organization in which you were an officer, partner, manager or member? . . . . . . . . . . .
8.
YES NO
(If "Yes", attach a detailed statement signed by you explaining the circumstances and current status,
and if no payment or payment arrangement has been made, the reason; a resume of employment and
business activities; and copies of the court complaint, judgment, documentation of payment
arrangements, lien documents, records of any payments, and other relevant documents.)
9.
Have you or any construction organization in which you were an officer, partner, manager or member ever
been adjudicated as bankrupt or is presently in the process of bankruptcy proceedings? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
YES NO
(If "Yes", attach a detailed statement giving the number of bankruptcy proceedings, the location of
the bankruptcy court, a schedule of creditors listed in the bankruptcy petition, the approximate date
of the action and a statement of the final action upon the proceedings.)
.)
(CONTINUED ON PAGE 3)
-2-
10.
11.
Have you or any construction organization in which you were an officer, partner, manager or member ever
made an assignment of assets, either voluntary or otherwise, in settlement of construction obligations for
less than the total amount of the indebtedness? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
YES NO
YES NOHave you ever been convicted of a crime in any jurisdiction that has not been annulled or expunged? . . . . . . . . . . . . . . . . .
(If "Yes", explain on a separate sheet the circumstances leading to the conviction and detailing
all activities since the conviction, including employment and business involvements. Include
job title, period of employment, employer's name, description of duties, and training attended.
Also, submit court documentation on the date, place, violation of each conviction and fulfillment
of conditions of each sentence.)
(If "Yes", attach a detailed statement listing names and addresses of all creditors and losses they sustained.)
AVERAGE SIZE OF COMPLETED PROJECTS (Give square footage or
anything that will describe physical dimension):
EXPERIENCE STATEMENT
Print Applicant Name:
(LAST, First, Middle)
Date:
J.
1. TYPE OF WORK & TIME AT EACH - I have worked as a: SKILLS - I can perform the following:3.
2. TOTAL TIME IN CONSTRUCTION: . .
Apprentice for . . . . . . . . . . . . . . .
yrs. mos.
Journeyman for. . . . . . . . . . . . . .
Supervisor for . . . . . . . . . . . . . . .
Superintendent for . . . . . . . . . .
Contractor for . . . . . . . . . . . . . . .
Foreman for . . . . . . . . . . . . . . . . .
yrs.
yrs.
yrs.
yrs.
yrs.
mos.
mos.
mos.
mos.
mos.
mos.yrs.
Project Manager for. . . . . . . . . .
yrs. mos.
for . . . .
yrs. mos.
Read a financial statement
Compute payroll
Balance a checking account
Read blueprints
Prepare job estimates
Order materials
Design & layout construction projects
Other (specify):
Other (specify):
LIST THE MOST RECENT EXPERIENCE FIRST: (ATTACH ADDITIONAL SHEETS IF NECESSARY)
K.
Name of Company License No.
Type of Business Company Engaged in
Address of Company
Dates employed:
Mo/Yr
to
Mo/Yr
Total:
Yr/Mo
Dates supervised:
Mo/Yr
to
Mo/Yr
Total:
Yr/Mo
No. of people supervised:
TYPE OF PROJECTS:
Apartments Office Buildings
Condominiums Remodeling
Custom Tract Houses
High Rise Other (specify):
Describe duties and responsibilities:
Hours worked per week:
AVERAGE GROSS DOLLAR VALUE OF COMPLETED PROJECTS:
$
-3-
(CONTINUED ON PAGE 4)
AVERAGE SIZE OF COMPLETED PROJECTS (Give square footage or
anything that will describe physical dimension):
Print Applicant Name:
(LAST, First, Middle)
Date:
LIST THE MOST RECENT EXPERIENCE FIRST: (ATTACH ADDITIONAL SHEETS IF NECESSARY)
K.
Name of Company License No.
Type of Business Company Engaged in
Address of Company
Dates employed:
Mo/Yr
to
Mo/Yr
Total:
Yr/Mo
Dates supervised:
Mo/Yr
to
Mo/Yr
Total:
Yr/Mo
No. of people supervised:
TYPE OF PROJECTS:
Apartments Office Buildings
Condominiums Remodeling
Custom Tract Houses
High Rise Other (specify):
Describe duties and responsibilities:
Hours worked per week:
AVERAGE GROSS DOLLAR VALUE OF COMPLETED PROJECTS:
$
-4-
Affidavit of Applicant:
I hereby certify that the statements, answers, and representations made in this application and in the documents attached are true and correct.
I understand that any misrepresentation is grounds for refusal or subsequent revocation of license and is a misdemeanor (Section 710-1017,
Sections 436B-19 and 444-17), Hawaii Revised Statutes.
I further certify that I have read and will abide by the provisions of Hawaii Revised Statutes, Chapter 444 and Hawaii Administrative Rules,
Chapter 77.
Date
Print Name of Applicant
Signature of Applicant
Release of Information to Third Party:
To assist me in the licensing process, I hereby authorize DCCA's staff to release any and all information regarding my application (including, but
not limited to application status) to the following third party:
Print name of Individual who is assisting you:
Name of Organization:
Signature of Applicant Date
Supporting certificates necessary to establish that the applicant's construction experience meets the minimum requirements must be attached
to the application -- See instruction sheet.
Additional certificate forms may be obtained from the office of the Board at 335 Merchant Street, Room 301, Honolulu, HI 96813 or you may
download forms from our website at: cca.hawaii.gov/pvl.
Print Form
EXPERIENCE CERTIFICATE - CONTRACTOR'S LICENSE
Access this form via website at: cca.hawaii.gov/pvl
IMPORTANT!! READ "COMPLETION OF THIS EXPERIENCE CERTIFICATION" (page 3) BEFORE COMPLETING THIS
CERTIFICATE.
THIS SECTION TO BE COMPLETED BY THE APPLICANT:
Name of Applicant: (First, Middle, Last)
Classification requesting (check one only):
THIS SECTION TO BE COMPLETED BY THE PERSON WHO WILL CERTIFY TO THE APPLICANT'S EXPERIENCE:
Indicate your BUSINESS RELATIONSHIP
to the applicant:
EMPLOYER
SUPERVISOR
RME Lic. #
FELLOW EMPLOYEE
JOURNEYMAN
OTHER (specify):
Classifications held:
From: To:
Employment Dates (mo/yr):
Length of service:
Yrs. mos.
Dates applicant has supervised:
From: To:
TOTAL TIME:
FULL-TIME
PART-TIME -
Hours per week, if
part-time
Indicate LEVEL applicant worked at:
JOURNEYMAN
FOREMAN
SUPERVISOR
CONTRACTOR
OTHER (specify):
Did the applicant demonstrate a level of knowledge and
skill expected of a journeyman or better in the craft(s) of
trade(s) listed above? (Check your answer.)
YES NO
Did the applicant demonstrate a history of honesty,
truthfulness, financial integrity and fair dealing?
YES NO
(Refer to the Board's definitions of each of the above levels
on the "Completion of this Experience Certification" page.)
DESCRIBE IN DETAIL THE APPLICANTS EXPERIENCE PERFORMING ON-SITE SUPERVISION AND DIRECTION OF EMPLOYEES IN THE
CLASSIFICATION INDICATED ABOVE (i.e. General Engineering, General Building, etc.):
(SIGNATURE REQUIRED ON PAGE 2 IN FRONT OF NOTARY)
CT-03 1017R
A - General Engineering B - General Building C -
Print Name of Applicant: Date:
Section 444-30, HRS, of the contractors license law provides that: Any person or his agent who files with the Contractors License Board any
notice, statement, or other document required under the provisions of the contractors license law, which is false or untrue or contains any
material misstatement of fact is guilty of a misdemeanor.
Certification of Person Completing this form:
I, hereby certify that I have personally known the person
named as applicant above; that I have direct knowledge of the applicant's supervisory experience which I have listed; and, all other statements
and answers given here are true and correct.
Date:
(Print name of certifier)
Signature of the Certifier in front of Notary Public
Subscribed and sworn to before me this
day of A.D. 20
.
Notary Signature:
Notary Public, State of:
My commission expires:
Print Name:
Doc. Date: No. of Pages:
Notary Name: Circuit Court:
Doc. Description
Notary Signature:
Date:
This material can be made available for individuals with special needs. Please call the Licensing Branch Manager at (808) 586-3000 to submit
your request.
-2-
DO NOT SEND THIS FORM TO THE CONTRACTORS LICENSE BOARD. INSTEAD, PLEASE RETURN IT TO THE APPLICANT SO THE
APPLICANT CAN ATTACH IT TO THE APPLICATION.
Print Your Name:
Address of Certifier:
Contractor's Lic. No. ENTITY: Contractor's Lic. No. RME:
Licensed Classifications of Certifier: State:
Home Phone No.: Business Phone No.:
( () )
Print Form
-3-
COMPLETION OF THIS EXPERIENCE CERTIFICATION
The applicant must detail four full years of supervisory experience within the past 10 years, in the classification the applicant
is applying for, at the level of a Journeyman, Foreman, Supervisor, or Contractor (see definitions below). The applicant must also
submit certificates to support this experience. The certificates must be completed by a qualified and responsible person; that is,
by an employer, fellow employee, or journeyman who has DIRECT KNOWLEDGE of the applicant's experience.
DIRECT KNOWLEDGE is knowledge of the truth in regard to a particular fact, which is original, and does not depend on
information or hearsay.
The applicant is requesting that you complete this form to certify as to your DIRECT KNOWLEDGE of the applicant's
experience. As a qualified and responsible person you must certify that the applicant demonstrated a level of knowledge
and skill expected of a journeyman or better in the classification for which the application is being made by describing in
detail the applicant's experience performing on-site supervision and direction of employees in the classification the
applicant is applying for.
JOURNEYMAN is an experienced worker in the trade who is fully qualified as opposed to a trainee, and is able to perform the
trade without supervision.
FOREMAN/SUPERVISOR is a person who has the knowledge and skill of a journeyman and also directly supervises the physical
construction.
CONTRACTOR is one or more of the following: 1) a currently licensed Hawaii contractor
2) a formerly licensed Hawaii contractor
3) a person listed under "Personnel of Record" on the license application of a
currently licensed Hawaii contractor
4) an out-of-state contractor who held a license in that state
A Contractor is a person who has the skills necessary to manage the daily activities of a construction business, including field
supervision.
Your cooperation is earnestly solicited so that the Contractors License Board can determine whether this applicant has the
experience necessary to become a capable and qualified contractor.
IMPORTANT: You may be requested to provide documentation to verify all experience to which you are attesting. For your
records, it is suggested that you keep a copy of the certificate you complete.
DO NOT SEND THIS FORM TO THE CONTRACTORS LICENSE BOARD. INSTEAD, PLEASE RETURN IT TO THE APPLICANT SO THE
APPLICANT CAN ATTACH IT TO THE APPLICATION.
EXPERIENCE CERTIFICATE - CONTRACTOR'S LICENSE
Access this form via website at: cca.hawaii.gov/pvl
IMPORTANT!! READ "COMPLETION OF THIS EXPERIENCE CERTIFICATION" (page 3) BEFORE COMPLETING THIS
CERTIFICATE.
THIS SECTION TO BE COMPLETED BY THE APPLICANT:
Name of Applicant: (First, Middle, Last)
Classification requesting (check one only):
THIS SECTION TO BE COMPLETED BY THE PERSON WHO WILL CERTIFY TO THE APPLICANT'S EXPERIENCE:
Indicate your BUSINESS RELATIONSHIP
to the applicant:
EMPLOYER
SUPERVISOR
RME Lic. #
FELLOW EMPLOYEE
JOURNEYMAN
OTHER (specify):
Classifications held:
From: To:
Employment Dates (mo/yr):
Length of service:
Yrs. mos.
Dates applicant has supervised:
From: To:
TOTAL TIME:
FULL-TIME
PART-TIME -
Hours per week, if
part-time
Indicate LEVEL applicant worked at:
JOURNEYMAN
FOREMAN
SUPERVISOR
CONTRACTOR
OTHER (specify):
Did the applicant demonstrate a level of knowledge and
skill expected of a journeyman or better in the craft(s) of
trade(s) listed above? (Check your answer.)
YES NO
Did the applicant demonstrate a history of honesty,
truthfulness, financial integrity and fair dealing?
YES NO
(Refer to the Board's definitions of each of the above levels
on the "Completion of this Experience Certification" page.)
DESCRIBE IN DETAIL THE APPLICANTS EXPERIENCE PERFORMING ON-SITE SUPERVISION AND DIRECTION OF EMPLOYEES IN THE
CLASSIFICATION INDICATED ABOVE (i.e. General Engineering, General Building, etc.):
(SIGNATURE REQUIRED ON PAGE 2 IN FRONT OF NOTARY)
CT-03 1017R
A - General Engineering B - General Building C -
Print Name of Applicant: Date:
Section 444-30, HRS, of the contractors license law provides that: Any person or his agent who files with the Contractors License Board any
notice, statement, or other document required under the provisions of the contractors license law, which is false or untrue or contains any
material misstatement of fact is guilty of a misdemeanor.
Certification of Person Completing this form:
I, hereby certify that I have personally known the person
named as applicant above; that I have direct knowledge of the applicant's supervisory experience which I have listed; and, all other statements
and answers given here are true and correct.
Date:
(Print name of certifier)
Signature of the Certifier in front of Notary Public
Subscribed and sworn to before me this
day of A.D. 20
.
Notary Signature:
Notary Public, State of:
My commission expires:
Print Name:
Doc. Date: No. of Pages:
Notary Name: Circuit Court:
Doc. Description
Notary Signature:
Date:
This material can be made available for individuals with special needs. Please call the Licensing Branch Manager at (808) 586-3000 to submit
your request.
-2-
DO NOT SEND THIS FORM TO THE CONTRACTORS LICENSE BOARD. INSTEAD, PLEASE RETURN IT TO THE APPLICANT SO THE
APPLICANT CAN ATTACH IT TO THE APPLICATION.
Print Your Name:
Address of Certifier:
Contractor's Lic. No. ENTITY: Contractor's Lic. No. RME:
Licensed Classifications of Certifier: State:
Home Phone No.: Business Phone No.:
( () )
Print Form
-3-
COMPLETION OF THIS EXPERIENCE CERTIFICATION
The applicant must detail four full years of supervisory experience within the past 10 years, in the classification the applicant
is applying for, at the level of a Journeyman, Foreman, Supervisor, or Contractor (see definitions below). The applicant must also
submit certificates to support this experience. The certificates must be completed by a qualified and responsible person; that is,
by an employer, fellow employee, or journeyman who has DIRECT KNOWLEDGE of the applicant's experience.
DIRECT KNOWLEDGE is knowledge of the truth in regard to a particular fact, which is original, and does not depend on
information or hearsay.
The applicant is requesting that you complete this form to certify as to your DIRECT KNOWLEDGE of the applicant's
experience. As a qualified and responsible person you must certify that the applicant demonstrated a level of knowledge
and skill expected of a journeyman or better in the classification for which the application is being made by describing in
detail the applicant's experience performing on-site supervision and direction of employees in the classification the
applicant is applying for.
JOURNEYMAN is an experienced worker in the trade who is fully qualified as opposed to a trainee, and is able to perform the
trade without supervision.
FOREMAN/SUPERVISOR is a person who has the knowledge and skill of a journeyman and also directly supervises the physical
construction.
CONTRACTOR is one or more of the following: 1) a currently licensed Hawaii contractor
2) a formerly licensed Hawaii contractor
3) a person listed under "Personnel of Record" on the license application of a
currently licensed Hawaii contractor
4) an out-of-state contractor who held a license in that state
A Contractor is a person who has the skills necessary to manage the daily activities of a construction business, including field
supervision.
Your cooperation is earnestly solicited so that the Contractors License Board can determine whether this applicant has the
experience necessary to become a capable and qualified contractor.
IMPORTANT: You may be requested to provide documentation to verify all experience to which you are attesting. For your
records, it is suggested that you keep a copy of the certificate you complete.
DO NOT SEND THIS FORM TO THE CONTRACTORS LICENSE BOARD. INSTEAD, PLEASE RETURN IT TO THE APPLICANT SO THE
APPLICANT CAN ATTACH IT TO THE APPLICATION.
EXPERIENCE CERTIFICATE - CONTRACTOR'S LICENSE
Access this form via website at: cca.hawaii.gov/pvl
IMPORTANT!! READ "COMPLETION OF THIS EXPERIENCE CERTIFICATION" (page 3) BEFORE COMPLETING THIS
CERTIFICATE.
THIS SECTION TO BE COMPLETED BY THE APPLICANT:
Name of Applicant: (First, Middle, Last)
Classification requesting (check one only):
THIS SECTION TO BE COMPLETED BY THE PERSON WHO WILL CERTIFY TO THE APPLICANT'S EXPERIENCE:
Indicate your BUSINESS RELATIONSHIP
to the applicant:
EMPLOYER
SUPERVISOR
RME Lic. #
FELLOW EMPLOYEE
JOURNEYMAN
OTHER (specify):
Classifications held:
From: To:
Employment Dates (mo/yr):
Length of service:
Yrs. mos.
Dates applicant has supervised:
From: To:
TOTAL TIME:
FULL-TIME
PART-TIME -
Hours per week, if
part-time
Indicate LEVEL applicant worked at:
JOURNEYMAN
FOREMAN
SUPERVISOR
CONTRACTOR
OTHER (specify):
Did the applicant demonstrate a level of knowledge and
skill expected of a journeyman or better in the craft(s) of
trade(s) listed above? (Check your answer.)
YES NO
Did the applicant demonstrate a history of honesty,
truthfulness, financial integrity and fair dealing?
YES NO
(Refer to the Board's definitions of each of the above levels
on the "Completion of this Experience Certification" page.)
DESCRIBE IN DETAIL THE APPLICANTS EXPERIENCE PERFORMING ON-SITE SUPERVISION AND DIRECTION OF EMPLOYEES IN THE
CLASSIFICATION INDICATED ABOVE (i.e. General Engineering, General Building, etc.):
(SIGNATURE REQUIRED ON PAGE 2 IN FRONT OF NOTARY)
CT-03 1017R
A - General Engineering B - General Building C -
Print Name of Applicant: Date:
Section 444-30, HRS, of the contractors license law provides that: Any person or his agent who files with the Contractors License Board any
notice, statement, or other document required under the provisions of the contractors license law, which is false or untrue or contains any
material misstatement of fact is guilty of a misdemeanor.
Certification of Person Completing this form:
I, hereby certify that I have personally known the person
named as applicant above; that I have direct knowledge of the applicant's supervisory experience which I have listed; and, all other statements
and answers given here are true and correct.
Date:
(Print name of certifier)
Signature of the Certifier in front of Notary Public
Subscribed and sworn to before me this
day of A.D. 20
.
Notary Signature:
Notary Public, State of:
My commission expires:
Print Name:
Doc. Date: No. of Pages:
Notary Name: Circuit Court:
Doc. Description
Notary Signature:
Date:
This material can be made available for individuals with special needs. Please call the Licensing Branch Manager at (808) 586-3000 to submit
your request.
-2-
DO NOT SEND THIS FORM TO THE CONTRACTORS LICENSE BOARD. INSTEAD, PLEASE RETURN IT TO THE APPLICANT SO THE
APPLICANT CAN ATTACH IT TO THE APPLICATION.
Print Your Name:
Address of Certifier:
Contractor's Lic. No. ENTITY: Contractor's Lic. No. RME:
Licensed Classifications of Certifier: State:
Home Phone No.: Business Phone No.:
( () )
Print Form
-3-
COMPLETION OF THIS EXPERIENCE CERTIFICATION
The applicant must detail four full years of supervisory experience within the past 10 years, in the classification the applicant
is applying for, at the level of a Journeyman, Foreman, Supervisor, or Contractor (see definitions below). The applicant must also
submit certificates to support this experience. The certificates must be completed by a qualified and responsible person; that is,
by an employer, fellow employee, or journeyman who has DIRECT KNOWLEDGE of the applicant's experience.
DIRECT KNOWLEDGE is knowledge of the truth in regard to a particular fact, which is original, and does not depend on
information or hearsay.
The applicant is requesting that you complete this form to certify as to your DIRECT KNOWLEDGE of the applicant's
experience. As a qualified and responsible person you must certify that the applicant demonstrated a level of knowledge
and skill expected of a journeyman or better in the classification for which the application is being made by describing in
detail the applicant's experience performing on-site supervision and direction of employees in the classification the
applicant is applying for.
JOURNEYMAN is an experienced worker in the trade who is fully qualified as opposed to a trainee, and is able to perform the
trade without supervision.
FOREMAN/SUPERVISOR is a person who has the knowledge and skill of a journeyman and also directly supervises the physical
construction.
CONTRACTOR is one or more of the following: 1) a currently licensed Hawaii contractor
2) a formerly licensed Hawaii contractor
3) a person listed under "Personnel of Record" on the license application of a
currently licensed Hawaii contractor
4) an out-of-state contractor who held a license in that state
A Contractor is a person who has the skills necessary to manage the daily activities of a construction business, including field
supervision.
Your cooperation is earnestly solicited so that the Contractors License Board can determine whether this applicant has the
experience necessary to become a capable and qualified contractor.
IMPORTANT: You may be requested to provide documentation to verify all experience to which you are attesting. For your
records, it is suggested that you keep a copy of the certificate you complete.
DO NOT SEND THIS FORM TO THE CONTRACTORS LICENSE BOARD. INSTEAD, PLEASE RETURN IT TO THE APPLICANT SO THE
APPLICANT CAN ATTACH IT TO THE APPLICATION.
IMPORTANT ANNOUNCEMENT
ADDENDUM TO CONTRACTOR LICENSE APPLICATIONS
CONCERNING THE SUBMITTAL OF A
CHRONOLOGICAL HISTORY OF PROJECTS FORM
EFFECTIVE IMMEDIATELY
Every applicant for a RESPONSIBLE MANAGING EMPLOYEE (RME) or a SOLE PROPRIETOR contractor's license must submit a
"Chronological History of Projects Form" ("Project List") as documentation of the applicant's previous supervisory work
experience. Use as many pages as necessary to verify your four (4) years of supervisory experience. The Project List may be
duplicated and is available on the Contractor License Board's website:
http://cca.hawaii.gov/pvl/boards/contractor/application_publication. Click on "Chronological History of Projects Form".
Submit a separate Project List for each classification the applicant intends to engage. Only include work experience performing
on-site supervision and direction of employees.
Please ensure that the Project List is filled out completely (provide information in each column of the form) and that it includes the
following:
10.17R
This material can be made available for individuals with special needs. Please call the Licensing Branch Manager at (808) 586-3000 to submit your request.
A description of your supervisory work experience performed in-house, with your own crew; and work or trades that were
subcontracted to other contractors; and the means and methods of each project listed.
The "Contract Amount" stated should be commensurate with information stated in the "Detailed Description of the Work You
Supervised".
The "Amount of Supervisory Experience" should only include the actual amount of time spent on-site supervising your own crew.
Do not include time spent for design, ordering materials, scheduling or downtime for rain-outs or waiting for delivery of
materials.
•
•
•
(CONTINUED ON NEXT PAGE)
11.17R
Print Form
NOTE: IF APPLYING FOR MORE THAN ONE
CLASSIFICATION, SUBMIT A SEPARATE
LIST FOR EACH.
CHRONOLOGICAL HISTORY OF PROJECTS COMPLETED
SAMPLE
Classification requested*
(Check one only)
"A" General Engineering
"B" General Building
"C"
Project
Start
Date
Project
End
Date Project Employer
Employer's
Classification
Position Title
(# of workers
supervised)
Detailed Description of
the Project and the
Work You Supervised
Contract
Amount**
Amount of
Supervisory
Experience**
(yrs/months)
1/12/14 6/22/14
John Doe
Residence
220 Palama Street,
Honolulu
John
Construction
"B" General
Building
Foreman - 8
workers
New residence - supervised
foundation, framing, roofing
with own crew. Coordinated
plumbing, electrical, and drywall
subcontractors
$200,000 5 months
8/1/13 5/1/14
J. Doe
Communications,
Honolulu, HI
John
Excavating Inc.
C-17
Excavating,
grading &
trenching
Construction
supervisor - 12
workers
Detailed description:
Construction of 90 site CMI/PCS
network. Project consisted of
excavating/trenching for
installation of new conduit &
manhole/vault systems. Grading
of affected work areas to normal
conditions.
Direct supervision of:
installation of new
communications conduits &
manhole systems by in-house
crews. Included excavation,
trenching, directional drilling &
surface restoration/grading
(asphalt & concrete).
$1,200,000
6 months
(Actual
supervisory time
- not the time
project is on the
books)
*You must submit a separate list for each classification requested.
**All information should be specific to the license classification you are applying for. As in the second example, if you are applying for a specialty classification, the contract
amount and years/months of supervisory experience should be specific to that specialty, and not the entire construction project (project start and end dates).
(FILLABLE FORM ON PAGE 3)
-2-
Classification requested*
(Check one only)
"A" General Engineering
"B" General Building
"C"
CHRONOLOGICAL HISTORY OF PROJECTS COMPLETED
Please Print Name:
Entity:
RME:
Sole Owner:
Project
Start
Date
Project
End
Date Project Employer
Employer's
Classification
Position Title
(# of workers
supervised)
Detailed Description of
the Project and the
Work You Supervised
Contract
Amount**
Amount of
Supervisory
Experience**
(yrs/months)
*You must submit a separate list for each classification requested.
**All information should be specific to the license classification you are applying for. As in the second example, if you are applying for a specialty classification, the contract
amount and years/months of supervisory experience should be specific to that specialty, and not the entire construction project (project start and end dates).
This material can be made available for individuals with special needs. Please call the Licensing Branch Manager at (808) 586-3000 to submit your request.
-3-
Print Form
Pursuant to §436B-9, Hawaii Revised Statutes, your application shall be considered abandoned and shall be destroyed if you fail
to provide evidence of continued efforts to complete the licensing process for two consecutive years. The failure to provide
evidence of continued efforts includes, but is not limited to:
(1) failure to submit any required information and documents requested by the licensing authority within two
consecutive years from the last date the documents and information were requested, or
(2) failure to complete any additional requirements for licensure that remain after approval of your application, such as
attempting to complete an examination requirement, within two consecutive years from the date your application was
approved, or
(3) failure to provide the licensing authority with any written communication during two consecutive years indicating
that you are attempting to complete the licensing process.
If an application is deemed abandoned, the applicant shall be required to reapply for licensure and comply with the licensing
requirements in effect at the time of the reapplication.
Frequently Asked Questions regarding Abandoned Applications
1) Q: If after receiving my application the board or program requests additional information, how much time do I
have to provide them with the requested information before my application is deemed abandoned?
A: You have two years from the date the information is requested.
2) Q: If I am an applicant who is required to take a licensing examination in order to complete the licensing process
and my application to take the licensing examination is approved, how much time do I have to complete the
examination requirement before my application is abandoned?
A: You must make an attempt to take the examination within two years from the date your application is
approved.
3) Q: What is meant by "attempt to take the examination?"
A: You must register and take the examination.
4) Q: If the statutes or rules of the boards or programs do not set time limits on taking and passing the examination,
and the only requirement left for me to become licensed is to pass the examination, and within the two year
period I should fail the examination, re-register for the examination, but fail again, will my application be
abandoned because I could not pass the examination within two years?
A: Your application will not be abandoned because you would have demonstrated your efforts to take the
examination by registering for and taking the examination.
(NOTE: Our office will only be notified of your efforts if you take the examination as a Hawaii candidate.
Examination results will not automatically be provided to our office if you sit for the examination via another
state board. Therefore, if you are in this situation, please arrange for the test results to be sent to us).
5) Q: What does it mean if my application is abandoned?
A: It means that your application is no longer valid, will be destroyed, and you shall be required to reapply and
comply with the requirements for licensure at the time of the reapplication. To reapply, you must submit a
new application and you will be required to comply with the licensing requirements and pay fees that are in
effect at the time you submit your new application.
12/10
7) Q: Will any of the documents that supplemented my first application be saved in case I need to reapply?
A: No. When you reapply, you will need to again provide us with documentation.
8) Q: Will the application fee that I paid with my first application carry over to cover the application fee for my new
application?
A: No. You will be required to again pay the non-refundable application fee.
9) Q: If my application has not been destroyed does this mean that it has not yet been deemed "abandoned?"
A: No. Simply because an application has not been destroyed does not mean that it has not been deemed
abandoned.
10) Q: If I am currently unable to complete the licensing process (eg., no continued effort), how do I prevent my
application from being abandoned?
A: You have two years to complete the licensing process. However, if you are unable to show continued effort
for two consecutive years but you still intend to complete the licensing process, you must send a written
communication to the board or program prior to the two year expiration explaining why you are unable to
complete the licensing process within two years. Your written communication shall also request approval to
complete the licensing process by a specific date after the two year expiration. You will be advised whether
your request is approved or disapproved. If disapproved, your application will be destroyed and you will need
to reapply for licensure.
11) Q: Who do I contact to find out if my application is soon to be abandoned?
A: You may contact the Licensing Branch at (808) 586-3000.
-2-
This material can be made available for individuals with special needs. Please call the Licensing Branch Manager at (808) 586-3000 to submit your request.
6) Q: Will you be providing a notice to me before my application is abandoned?
A: It is not required that we notify you before your application is abandoned. However, some boards and
programs have taken the initiative to send out notifications.
Print Form
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Require App For Contractor RME 11.17R (Hawaii)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 24 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document