Master Plumber Examination Application - Texas State Board Of Plumbing Examiners (Page 2 of 2) in pdf

TEXAS STATE BOARD OF PLUMBING EXAMINERS

PO BOX 4200, AUSTIN, TEXAS, 78765 ▪ 512-936-5200 ▪

MASTER PLUMBER EXAMINATION APPLICATION

Revised August 2014

1. Date _______________ ►Incomplete applications expire one year from receipt. See instructions in #10, below.

2. Last name (Print) _________________________________ First _________________________ MI ________

3. Mailing address _______________________________________________ City _________________________

4. State _____________ Zip Code __________________ Date of birth ___________________ Age ___________

5. Driver’s License/ID No. ________________________ Social Security No. ______________________________

Disclosure of your social security number is required. Your social security number is being solicited pursuant to Texas Family Code Section 231.302

for use by the state’s Title IV-D agency to assist in the administration of laws relating to child support enforcement under 42 U.S. C Sections 601-617

and 651-669.

6. Texas Plumber License # _____________ or Out-of-State License # ______________ issued by State of ______

7. Home Tel. # __________________ Mobile Tel. # __________________ Email __________________________

8. Employed by _________________________________________ Employer Tel. # _______________________

9. Have you ever been convicted of a felony in this state or any other state?

Yes  or No  If you answer yes to this question, you must submit a Supplemental Criminal History Information

Form and all documentation listed on page 2 of the Form with this application. The Supplemental Criminal History

Information Form is available on the TSBPE website at

(under Application and Forms).

10. Check the following boxes as you include the items which must be submitted with this application in

order for the application to be considered complete and be processed.

 Non-refundable examination fee of $175 (cashier’s check, money order, or personal or company check).

 Copy of high school diploma or General Equivalency Diploma (GED).

 Proof that the applicant is a citizen or national of the United States, or an alien lawfully admitted to the United

States for permanent residence, or an alien authorized to work lawfully in the United States. Applicable proof

includes any of the following: (1) a certified copy of your birth certificate issued by a city/county/state/federal

certifying authority (if born in the United States); or (2) a certified copy of your Consular Report of Birth (if born

abroad to a U.S. citizen/parent); or (3) a legible copy of both sides of your Certificate of Naturalization or

Certificate of Citizenship (if a naturalized U.S. citizen); or (4) a legible copy of both sides of the U.S. Immigration

and Naturalization Service document evidencing your current status (if a permanent resident alien or an alien

authorized to work lawfully in the United States, or any other status). Foreign birth certificates are not accepted.

 Legible copy of current photographic identification issued by the State of Texas or another state or jurisdiction.

 Supplemental Criminal History Information Form and required documents (if you answered “yes” to #9).

 If licensed in another state, submit official verification letter from the agency which issued the license.

 Copy of official certificate of completion of a training program approved by the United States Department of Labor

Office of Apprenticeship, if applicable. (See page listing minimum requirements.)

 YES or  NO Are you an active or inactive military service member?

(for verification of plumbing training obtained in the military, call 512-936-5250)

11.

BY SIGNING BELOW, I TESTIFY THAT I UNDERSTAND THAT SUBMITTING ANY FALSE INFORMATION

TO THE BOARD IS A CRIMINAL OFFENSE AND WILL ALSO RESULT IN DISCIPLINARY ACTION, UP TO AND

INCLUDING REVOCATION OF MY PLUMBING LICENSE OR REGISTRATION AND AN ADMINISTRATIVE

PENALTY UP TO $5,000.00.

__________________________________________

Signature of applicant

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

TSBPE USE ONLY

Fee ______________________________________________ File No. _______________________

1. SCHED: ________________[____] 2. SCHED: _____________[_____] 3. SCHED: ______________[______]

Master Plumber Examination Application - Texas State Board Of Plumbing Examiners Page 2

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