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.

    *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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