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Form 08-4033b - Certificate In Support Of Applicant'S Experience And Qualifications - Division Of Occupational Licensing Page 2

MECHANICAL SYSTEMS TEMPERATURE CONTROL (CONTL) - 12 AAC 39.282

practical experience as a journeyman in mechanical systems temperature control work for at least two of the four years

immediately before the date of application; or

management experience in mechanical systems temperature control work as a field superintendent or similar position

for at least four of the six years immediately preceding the date of application; or

a degree in mechanical engineering from a nationally or regionally accredited college or university plus practical

experience as a journeyman or field engineer in HVAC and sheetmetal work for at least one of the three years

immediately before the date of application.

RESIDENTIAL PLUMBING AND HYDRONIC HEATING (RPHH) - 12 AAC 39.302

practical experience as a journeyman in residential plumbing and hydronic heating work for at least two of the four years

immediately preceding the date of application.

UNLIMITED COMMERCIAL AND INDUSTRIAL PLUMBING (UCIP) - 12 AAC 39.202

practical experience as a journeyman for at least four of the six years immediately before the date of application; or

management experience in plumbing work as a field superintendent or similar position for at least four of the six years

immediately before the date of application; or

a degree in mechanical engineering from a nationally or regionally accredited college or university plus practical

experience as a journeyman plumber or field engineer in outside linework for at least one of the three years immediately

before the date of application; or

a registration in the State of Alaska as a professional mechanical engineer plus management experience in the

mechanical contracting industry as a field engineer or in a similar engineering position for at least one of the three years

immediately before the date of application.

Please list the applicant’s actual work experience as related to the items you checked above:

Dates Worked

Name of Employer

Position

Began

Ended

Described in detail the type of work performed by the applicant (trades and duties):

Are you licensed in the mechanical industry?

Yes

License Number:

State:

Expiration Date:

License Category(ies):

I CERTIFY that the information provided is true and correct to the best of my knowledge. I further recommend the applicant as being professionally

capable, reliable, and worthy of confidence.

Signature

Printed name

Address (Street No. or P.O. Box)

City

State

Zip Code

SUBSCRIBED AND SWORN before me this

day of

Notary Public

NOTARY SEAL

My Commission Expires:

08-4033b (Rev. 8/00)

Form 08-4033b - Certificate In Support Of Applicant'S Experience And Qualifications - Division Of Occupational Licensing Page 2

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