Individual Trade License Application

2. 
4. Individual Trades License Application
6. License #
7. Exam Score
8. Receipt #
10. Date
    Date
11. Type:

    1. New License
    2. Renewal of License
13. Applicant Name
14. Phone Number
16. Address
17. City
18. State
19. Zip
21. Email Address
23. Please select license type:

    1. Master $40/2 years
    2. Journeyman $20/2 years
    3. Certification $40/2 years
24. Please select license Category:

    1. Electrician
    2. Mechanical

    1. Plumber With Gas
    2. Drainlayer

    1. Irrigation
    2. Sheetmetal
26. * Applicants for new licenses must provide proof of minimum exam score of 75%
    Please upload your exam score sheet
27. Continuing Education Certificates
    12 CEU hours are required to renew license. Please upload certificates here.
29. *All persons applying for Master license must have 4 years practical experience. **************************************
    *All persons applying for Journeyman license must have 2 years practical experience.********************************* *Fees are not prorated.
31. EDUCATION: Please list relevant college, vocational or trade education:
33. Name of School
34. Address
35. City
36. State
38. Zip
39. Dates Attended
41. Name of School
42. Address
43. City
44. State
46. Zip
47. Dates Attended
49. EMPLOYMENT RECORD: Please list present employer first:
51. Name of Employer
52. Phone Number
53. Address
54. City
56. State
57. Zip
58. Employed From:
    Employed From: Start Date

    —

    Employed From: End Date
60. Name of Employer
61. Phone Number
62. Address
63. City
65. State
66. Zip
67. Employed From:
    Employed From: Start Date

    —

    Employed From: End Date
69. Upload any additional documents
71. **After submitting your application and proper paperwork, we will review and send you an "ok to pay" email with a link to pay online.
73. By signing below, I certify that all statements made in this application are true, and I understand that any false statements on this application shall be considered sufficient cause for disqualification.
75. eSignature
    I understand and agree that by typing my name above I am providing a legal signature on this application.
76. Date
    Date
78. *Applications are not valid until all paperwork and payments are received by the Risk Reduction Office. It is our policy to provide individuals with disabilities and equal opportunity to participate in, and enjoy the benefits of, our services, programs and activities. In order for us to provide a suitable accommodation, we ask that you request what assistance you desire by contacting the Risk Reduction Office, 2000 Denison Ave, Manhattan, KS, or by calling (785) 587-4506 or call the TDD Kansas Relay center at (800) 766-3777. We are here to assist you.
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80. 1. Receive an email copy of this form.
81. Email address

    This field is not part of the form submission.

82. Submit Submit and Print

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