Form Cc-008 - Certificate Of Competency Application Page 18
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26CERTIFICATE OF COMPETENCY APPLICATION
Form B
Section 7- Employment History Form
Employment history provided must demonstrate the appropriate time frames based on the construction
trade in which you are applying for, please start with the most recent. Information will be verified. If there
is additional employment history, please make copies of this section and complete.
Employer Name:
Dates Employed (mm/yyyy to mm/yyyy)
Employer Address:
Employer Phone Number:
Name of qualifying contractor for employer:
License number of qualifying contractor:
Contact Name:
Role (Check the one that applies)
Worker or Supervisor
Email:
Describe job duties:
Time during duration of employment:
As a worker_____________ As a supervisor ______________
Note: the time reported needs to equal or exceed the number of years of experience for the required trade.
Form CC-08-08
Employment History
Rev. 12/9/16
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