Request For Specialty Subcontract Labor Only Classification(S) Based On Experience And Contractor Reference Page 3

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State of Louisiana
State Licensing Board for Contractors
2525 Quail Drive, Baton Rouge, LA 70808 1-800-256-1392 Fax (225) 765-2362
REQUEST FOR SPECIALTY SUBCONTRACT LABOR ONLY
CLASSIFICATION(S) BASED ON EXPERIENCE AND
CONTRACTOR REFERENCE
Instructions to Applicant:
Please fill out the information below and submit this form with your application. Use a separate
form for each additional Qualifying Party for which examination exemption is requested.
Name (as it appears on the license/license application):
Subcontract Labor Only Classification(s) Being Requested:
RESUME FOR QUALIFYING PARTY CANDIDATE FOR APPLICATION
USE ADDITIONAL PAGES AS NECESSARY
Current Employment of Qualifying Party Candidate (name of Business or Employer):
Address:
City:
State:
Zip Code:
Dates Employed
Job Title:
From:
To: Present
Description of Duties Performed Under this Job Title (Please print or type):
Previous Employer:
Address:
City:
State:
Zip Code:
Dates Employed
Job Title:
From:
To:
Description of Duties Performed Under this Job Title (Please print or type):
Please list and/or describe all relevant education or training of the Qualifying Party Candidate

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