Tdlr Form Oo4acr - Air Conditioning & Refrigeration Contractor Template Page 2
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48.
Have you ever had a business license, certification or registration suspended, revoked or denied in
any state?
YES
NO
If YES, submit a “Disciplinary Action Questionnaire” with this application.
CHECK EACH CLASS AND ENDORSEMENT FOR WHICH YOU ARE APPLYING
NOTE: ALL EXAM FEES WILL BE PAID DIRECTLY TO PSI. DO NOT SEND EXAM FEES TO THE DEPT.
NOTE: The classes and endorsements for the Air Conditioning license are explained on the instructions sheet
and under the Frequently Asked Questions on the TDLR website at
CLASS A ENVIRONMENTAL AIR CONDITIONING
CLASS B ENVIRONMENTAL AIR CONDITIONING
CLASS A COMMERCIAL REFRIGERATION/PROCESS COOLING AND HEATING
CLASS B COMMERCIAL REFRIGERATION/PROCESS COOLING AND HEATING
EMPLOYMENT HISTORY
10. The Employment History must be completed on this application. Your employment history should indicate at
least 36 months of practical experience with the tools of the trade in the preceding (5) years.
(See Attachments below for information regarding “self employment”.)
A
TTACHMENTS
11. Attach an Experience Verification Form which indicates at least 36 months of practical experience with
the tools of the trade in the preceding 5 years.
(Several forms may be attached.)
(See Section 1302.255 (a) of the Air Conditioning and Refrigeration Contractors Occupations Code.)
If you are “self-employed”, documented proof is required. Documented proof consists of copies of: service
orders, contracts, invoices, or letters from former customers. This information should include dates, type of
work performed and names of customers. Submit at least 3 documents per year for 3 of the last 5 years.
12. Attach a transcript or diploma showing a degree in air conditioning engineering, refrigeration engineering, or
mechanical engineering if you wish to use credit for air conditioning and refrigeration courses to fulfill up to two
years of the required 36 months of practical experience with the tools of the trade.
(See Section 1302.255 (b) of the Air Conditioning and Refrigeration Contractors Occupation Code.)
13. If you are applying by RECIPROCITY, you must complete this application, submit a letter of good standing
from the reciprocating state, a copy of the license, and a completed certificate of insurance.
Texas reciprocates with South Carolina and Georgia. Further information maybe obtained on the application
instructions or on the TDLR website at
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R
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F
OTICE
EGARDING
PPLICABLE
EES
14. If you submit an insufficient fee amount with this application, or submit an outdated application form, it may be
returned to you. To verify the correct form version and required fees, consult the TDLR web site
( ) or contact TDLR using the information at the top of the first page.
The License Application Fee is $115 and Application fees are NOT refundable.
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O
A
TATEMENT
F
PPLICANT
15.
By signing this application I certify all information submitted on this and attached forms is true and accurate. I authorize
TDLR to conduct any investigations of me which it deems prudent. I understand that the information revealed in an investiga-
tion may be cause for disapproval of the application even though other requirements for a license have been met. I understand
that the contents of the qualifying examination are confidential and that revealing questions and answers to another applicant or
to any person associated with a school or examination preparation course is grounds for disapproval of the application or
revocation of my license. If I am asked to reveal the contents of an examination, I will not do so.
________________________
________________________________________________
Date Signed
Signature of Applicant
NOTE 1: The Department will add your address to the Air Conditioning Contractors email notification list, which automatically provides infor-
mation from the Department on matters affecting Air Conditioning and Refrigeration. Your email address is confidential pursuant to the Texas
Public Information Act and the Department will not share it with the public.
See additional information at the following link:
NOTE 2: State law prohibits renewing a license more than once after a licensee has defaulted on a student loan guaranteed by the Texas
Guaranteed Student Loan Corporation (TGSLC) unless the licensee has entered into a repayment agreement with TGSLC. YOU SHOULD
CONTACT TGSLC BEFORE FILING THIS APPLICATION if you have defaulted on a student loan. An application or renewal may be rejected
if this agency has received information from TGSLC that the applicant has defaulted on a student loan. The Texas Guaranteed Student Loan
Corporation can be contacted at: Texas Guaranteed Student Loan Corporation, P.O. Box 15996, Austin, Texas 78761-5996, Telephone:
1-800-222-6297.
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