Plumber License Application/affidavit Form - West Virginia Division Of Labor

ADVERTISEMENT

WEST VIRGINIA DIVISION OF LABOR
State Capitol Complex - Building 6, Room B-749 - Charleston, WV 25305
Telephone: (304) 558-7890
Facsimile: (304) 558-5174
Plumber License Application/Affidavit
General Information:
(Please Print)
Name: ________________________________________ Phone #: ____________________________
First
Middle Initial
Last
Social Security Number: ____________________________ Date of Birth: _____________________
Mailing Address: ___________________________________________________________________
City: __________________________ State: __________ Zip: __________ County: ______________
Have you ever been certified as a plumber in WV? Yes
No
If yes, License #:___________
Type of License:
(Please mark appropriate classification for which you are applying)
Master Plumber
(I certify I have at least twelve thousand hours (12,000) of plumbing experience)
Journeyman Plumber
(I certify I have at least eight thousand hours (8,000) of plumbing experience)
Plumber in Training
(I understand I am required to work under the direct supervision of a licensed
Master or Journeyman Plumber when performing plumbing work)
(No Examination Required)
Examination:
A Master or Journeyman Applicant is required to submit their examination score report with this
application/affidavit.
__________________________
__________________________
(Date of Examination)
(Score)
Fee: Master - $75.00
Journeyman - $75.00
Plumber in Training - $50.00
Please attach a check, certified check, cashier’s check or money order made payable to the West Virginia
Division of Labor,
NO CASH PLEASE.
PRIVACY NOTICE
The Division of Labor processes your personal information for appropriate and customary business purposes. Your personal information may be
disclosed to other State agencies or third parties in the normal course of business as needed to comply with State or Federal laws. If you have any
questions about the Division of Labor's use of your personal information or would like a copy of the Division's complete privacy notice, please contact
Robert Bryant at Robert.L.Bryant@wv.gov.
The undersigned hereby certifies under penalty of perjury that information provided on this application/affidavit is true to the best of my knowledge and
belief and that I realize that making a false statement may result in loss of my license.
Signature: ___________________________________________
Date: _________________________
(Applicant’s Signature)
Subscribed and sworn to before me, the undersigned Notary Public this _____ day of ________________,
20 _____. My commission expires _______________________.
____________________________
Notary Public

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go