Application For Reinstatement Form (Page 2 of 2) in pdf

Application For Reinstatement Form Page 2

INSTRUCTIONS FOR REINSTATEMENT

1. Complete application in detail, especially the record of employment, giving dates

and complete address.

2. The board may grant a deferred license without deferment or reinstatement fees to

members of the armed forces or Class A, B, C HVACR license holders who

become legally appointed or employed Mechanical Inspectors.

3. A Class A, B or C HVACR license holder, whose license expired for non-payment

of renewal fees, may make application to the Board for reinstatement of license. A

penalty fee of $10.00 per month shall be added for late payment. The application

must be supported with an amended experience record covering all experience

subsequent to the date of the lapse. Upon receipt of the application and experience

record, the Board will determine whether to reinstate with or without examination.

4. The Board shall reinstate a deferred license provided the applicant pays the current

license fee for the type of license requested. If the applicant has been deferred for

over a five (5) year period, the Board may request that the applicant complete a

reinstatement form outlining work experience. If it has been determined by the

Board that the applicant has not been affiliated with HVACR work since the

original date of deferment, an examination may be required.

5. A Class A, B or C Contractor or Registrant whose license has been revoked may

make application for a new license one (1) year after the date of revocation. Such

application shall contain a statement of intent to comply with all pertinent laws and

regulations. The Board shall issue a new license after the applicant has passed the

prescribed examination and paid applicable fees.

6. Record of your employment since your last date of licensing.

___________________________________________________________________

_____________________________________________________________

7. DO NOT SUBMIT FEES WITH APPLICATION. YOU WILL BE BILLED AT A

LATER DATE.

HVAC/R OFFICE USE ONLY

BACK FEES: ___________ APPLICATION APPROVED: ____

PENALTIES: ___________ DISAPPROVED: ______________

CURRENT FEES: _______ EXAM REQ: YES ____ NO______

TOTAL FEES: __________ DATE: _______________

Application For Reinstatement Form Page 2