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Application for Journeyman - St. Lucie County

Application for Journeyman - St. Lucie County

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ST. LUCIE COUNTY APPLICATION<br />

App. Fee: $35.00 Date: _______________ Certificate #: ____________________<br />

DO NOT WRITE ABOVE THIS LINE<br />

INSTRUCTIONS:<br />

PAYMENT IS REQUIRED AT THE TIME OF SUBMITTING AN APPLICATION TO COUNTY<br />

EXAMINING BOARD. APPLICATION FEES ARE NOT REFUNDABLE. ALL CHECKS WILL BE MADE<br />

PAYABLE TO: ST. LUCIE COUNTY. THE APPLICATION IS AN AGREEMENT AUTHORIZING THE<br />

EXAMINING BOARD TO OBTAIN ANY ADDITIONAL INFORMATION CONCERNING THE<br />

APPLICANT'S APPLICATION. THIS INFORMATION MAY CONCERN THE APPLICANT=S<br />

FINANCIAL, CREDIT, COLLECTIONS, TAX LIEN STATUS’ AND JUDGMENTS. A CONVICTION OF A<br />

FELONY IN THE LAST FIVE YEARS MAY RESULT IN A DENIAL OF YOUR LICENSE, PER ST. LUCIE<br />

COUNTY CODE OF ORDINANCES.<br />

(CHECK ONE)<br />

JOURNEYMAN TYPE<br />

(1) ELECTRICIAN<br />

(2) PLUMBING<br />

PLEASE PLACE<br />

PHOTOGRAPH OF<br />

APPLICANT HERE.<br />

PHOTO MUST BE FULL-<br />

FACED VIEW<br />

APPROXIMATELY 2”x 2”.<br />

A CLEAR &<br />

RECOGNIZABLE<br />

LIKENESS.<br />

APPLICANT’S SOCIAL SECURITY #: ___________________________<br />

APPLICANT’S NAME:<br />

___________________________________________________________________<br />

(FIRST) (MIDDLE) (LAST)<br />

HOME ADDRESS: ____________________________________ HOME PHONE: _____________________<br />

CITY: ___________________________ COUNTY: _______________ STATE: ________ ZIP___________<br />

E-MAIL ADDRESS: _______________________________________________________________________<br />

PLACE OF BIRTH: ___________________________ DATE OF BIRTH: ________________ SEX: ________<br />

CITIZEN OF UNITED STATES: YES ( ) NO ( )<br />

GRADE SCHOOL: __________YRS.<br />

HIGH SCHOOL: __________YRS. COLLEGE _________YRS.<br />

TRADE SCHOOL OR SPECIAL COURSE: ____________________________________________________<br />

FLORIDA DRIVER’S LICENSE NUMBER: _____________________________________________________<br />

<strong>Application</strong> <strong>for</strong> <strong>Journeyman</strong> Electrical or Plumber<br />

Revised: 12/9/13<br />

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