Get MO Application For Certificate Of Qualification - City Of Kansas City 2020-2024

Signature Date Information related to experience education and references is not required from applicants for the residential building supervisor certificate of qualification therefore such applicants may leave these portions of the application form blank. APPLICATION FOR CERTIFICATE OF QUALIFICATION City of Kansas City Missouri City Planning Development Department Development Services Contractor Licensing Branch th 5 Floor City Hall 414 East 12 Street Kansas City Missouri 64106-2792 Telephone 816 513-1500 x 6 Fax 816 513-1519 Application fee 53. 00 Exam fee To be paid directly to testing agency Check number Postmark date Account number NOTE Fill in the application carefully and completely. The information given will be used to determine your eligibility. Check one of the following certificate categories Supervisor Certificate Classifications Operator and Journeyman Certificate Classifications Demolition supervisor class I Electrical supervisor Elevator supervisor class I Fire protection supervisor class I Gas-fired appliance supervisor Heating and ventilating supervisor Master limited electrician Master electrician Master pipe fitter Master plumber Refrigeration supervisor Residential building supervisor Sign supervisor Fireman Journeyman plumber Operating engineer Plant fireman Steam operating engineer Date Applicant s name Last name First name Middle name Suffix Home address Street address City State Home phone number Business phone number Cell phone or pager number Zip Fax number Social Security number Date of birth I do hereby make application for a certificate to supervise and/or perform regulated tradeswork in accordance with the regulations contained in Chapter 18 of the City of Kansas City Missouri Code of Ordinances. See certification requirements for exceptions to exam fees. -1- EXPERIENCE Give a complete statement of your work history relevant to your trade beginning with your most recent employer. Do not include unrelated work experience. You may attach additional sheets if necessary. Employed from to Company Supervisor Address Supervisor s phone number Company s phone number Scope of work you performed for this company List any pertinent licenses certificates or registrations which you have held. Show dates and jurisdictions. -2- EDUCATION Circle last grade of school completed* 1 Name of high school Date left Address of high school High school diploma Yes No If you have no high school diploma have you obtained a certificate of equivalency on the GED test Yes No Name of trade school Dates attended Address of trade school Certificate received Name of college No* of credit hours Address of college Degree/year Any additional information pertaining to your education or experience may be furnished below. REFERENCES List below four individuals two of whom are engaged in your line of work whom the Building Official or a designee may contact for information pertaining to your character and professional ability. Do not name individuals who have provided reference letters or questionnaires on your behalf your own employees past or present individuals under your supervision past or present employees of the Department of CPD-DS employees of the third-party testing agency or material suppliers.