Fill and Sign the Curriculum Content Pde 3128c Form

APPLICATION FOR HEATING, AIR CONDITIONING AND VENTILATION CONTRACTORS MISHAWAKA H.V.A.C. ORDINANCE NO. 3792 CHAPTER 150; SECTION 150.62 ALL APPLICATIONS WILL BE REVIEWED BY THE H.V.A.C. EXAMINATION BOARD. YOU WILL BE NOTIFIED IF YOU ARE ELIGIBLE TO TAKE THE H.V.A.C. EXAMINATION. NO PERSONS SHALL BE EXAMINED FOR A LICENSE UNLESS THEY HAVE HAD AT LEAST FOUR (4) YEARS EXPERIENCE IN THE H.V.A.C. FIELD OF RESIDENTIAL, COMMERCIAL, OR INDUSTRIAL CONSTRUCTION, AND ARE ABLE TO FURNISH PROOF OF SUCH FACT. A CERTIFICATE OR DIPLOMA FROM A RECOGNIZED SCHOOL OF H.V.A.C. WILL BE ACCEPTABLE IN LIEU OF TWO (2) OF THE FOUR (4) YEARS REQUIRED. TWO (2) YEARS H.V.A.C. EXPERIENCE IN THE UNITED STATES MILITARY SERVICE WILL ALSO BE ACCEPTABLE IN LIEU OF ONE (1) YEAR OF THE FOUR (4) NOTED ABOVE. NO MORE THAN TWO (2) YEARS CREDIT SHALL BE GIVEN FOR ANY COMBINATION OF SCHOOL, WORK AND /OR MILITARY EXPERIENCE. YOU MUST HAVE A LETTER OF REFERENCE FROM EACH CONTRACTOR OR EMPLOYER LISTED IN THE APPLICATION VERIFYING YOUR EMPLOYMENT AND DUTIES. A FEE OF $10.00 MUST ACCOMPANY THE APPLICATION. THE H.V.A.C. EXAMINATIONS WILL BE HELD TWICE A YEAR; THE FIRST MONDAY OF MARCH AND THE LAST FRIDAY OF SEPTEMBER. THIS APPLICATION MUST BE SUBMITTED A MINIMUM OF THIRTY (30) DAYS PRIOR TO THE TESTING DATE. A GRADE NOT LESS THAN 70% WILL BE ACCEPTABLE. A PERSON WHO PASSES THE EXAMINATION WILL BE ISSUED A LICENSE AFTER THEY POST A $5,000.00 PERFORMANCE BOND AND $100.00 LICENSE FEE PAYABLE TO THE CITY OF MISHAWAKA. ANY PERSON WHO HAS PASSED THE REQUIRED EXAMINATION, AND WHO HOLDS A LICENSE FROM ST. JOSEPH/SOUTH BEND, INDIANA AND IS IN GOOD STANDING IS EXEMPT FROM THE EXAMINATION REQUIREMENTS CONTAINED IN THE MISHAWAKA ORDINANCE. HOWEVER, SUCH INDIVIDUALS MUST PAY THE MISHAWAKA APPLICATION AND LICENSE FEE. APPLICATION FOR HEATING, AIR CONDITIONING AND/OR VENTILATION CONTRACTORS EXAMINATION & LICENSE FOR THE CITY OF MISHAWAKA, INDIANA NAME OF APPLICANT: __________________________________________________ DATE: _____________________ If applicant represents a firm or corporation, give firm name and names of officers: __________________________________ ADDRESSES: Business: ___________________________________ ___________________________________ TELEPHONE NUMBERS: Business: _________________________________________ _________________________________________ Residence: __________________________________ ________________________________________ __________________________________ ________________________________________ OCCUPATION FOR LAST FIVE (5) YEARS: Firm Name and Address: _________________________________________________________________________________ Phone No.: _________________ Duties: _______________________________________ Years: _________________ Firm Name and Address: _________________________________________________________________________________ Phone No.: __________________ Duties: _______________________________________ Years: _________________ Firm Name and Address: _________________________________________________________________________________ Phone No.: __________________ Duties: _______________________________________ Years: _________________ (List any other on the reverse side) YEARS OF EXPERIENCE – As Journeyman _____________________ As Contractor ______________ Have you ever been examined for Journeyman or Heating/AC Contractor in any other city or state: _________________________ Where: _______________ Date: ________________ Journeyman: ___________________ Heating/AC Contractor: ____________________________ Were you successful: _____ Names of the Secretaries of the Boards giving examinations _______________________________________________________________________________ EDUCATION – Years Grade School: _____ High School: _____ Trade School: _____ Night School: _____ Others: _______________________ A FEE OF $10.00 MUST ACCOMPANY THIS APPLICATION STATE OF INDIANA ) ) SS: ST. JOSEPH COUNTY ) _________________________________, being duly sworn upon his oath, deposes and says that all statements made in the (Name of Applicant) above application are true, and said statements are made for the purpose of securing an examination and obtaining a license as a Heating/AC Contractor in the County of St. Joseph, Indiana. Subscribed and sworn to before me, a Notary Public, in and for said County and State, this ________________ day of _____________________________, __________. _____________________________________________ Notary Public, Residing in St. Joseph County, Indiana My commission expires on _____________________