Form Cc-008 - Certificate Of Competency Application Page 2
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26CERTIFICATE OF COMPETENCY APPLICATION
Please type or print all information clearly; complete all sections of the application in
its entirety. Additional information for each section is outlined in the step by step
application instructions.
Section 1 – Type of Application
by Examination or by Reciprocity from
1.1.
Type
(Check One):
________________________________________County
1.2.
Classification / Trade
(Check One):
General
Building
Residential
Electrical
Plumbing
HARV
Specialty
__________________________________________________________
(specify trade):
Active
Inactive
1.3.
Certificate Status:
or
$225.00 Check, Money Order, Cashier’s Check, etc.
1.4.
Application Review Fee
(Check One):
Section 2 – Applicant Personal Information
2.1.Photograph
(Attach photo in this area)
2.2.Full Legal Name
First:
Middle:
Last:
Birth Date:
Gender:
(mm/dd/yyyy)
Male
Female
Page 1 of 8
Form CC-008
Certificate of Competency Application
Rev. 12/9/16
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