USVI Public Records

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Department of Licensing and Consumer Affairs 3000 Estate Golden Rock, Suite 9 St. Croix, VI 00820-4311 Telephone: 340.713.3522 (DLCA) Facsimile: 340.773.6982 VIRGIN ISLANDS PLUMBERS’ & MECHANICAL LICENSING BOARD Attach 3 2x2 photos of Applicant here APPLICATION FOR EXAMINATION Part I In accordance with the provisions of 27 V.I.C. Ch. 7, which regulates Trades & Crafts in the U.S. Virgin Islands, I hereby apply for the following examination: Plumbing Examination $300.00 HVAC Mechanic Exam $200.00 Non-Refundable Application Fee $ 50.00 * Only the application fee will be accepted at the time application is submitted. Part II 1. Full Name __________________ _________________ ______________ First Middle Last 2. Physical Address: ______________________________________________ 3. Mailing Address: ______________________________________________ 4. Business Address: _____________________________________________ 5. Business # ( ) ______________ 6. Home # ( ) ______________ 7. Birth Date: ____________________ 8. Birth Place: ________________ 9. Citizenship: ___________________ 10. Naturalized: ( ) yes ( ) no 11. Social Security Number: _______________ Email: ____________________ 12. Virgin Islands Resident? ( ) yes ( ) no If yes, how long? ______ 13. Present Business Activity: ________________________________________ 14. In which state(s) do you currently hold registration/licensure: ____________ __________________________________________________________________ __________________________________________________________________ 15. Has your license ever been revoked? ( ) yes ( ) no If yes, please explain: ________________________________________________ __________________________________________________________________ __________________________________________________________________ 16. Have you ever been censured for unprofessional conduct? ( ) yes ( ) no If yes, please explain: ________________________________________________ __________________________________________________________________ __________________________________________________________________ 17. Have you ever been convicted of a felony? ( ) yes ( ) no If yes, please explain: ________________________________________________ __________________________________________________________________ __________________________________________________________________ Part III 18. REFERENCES: Please provide two (2) professional references from licensed plumbers or hvac mechanical contractor, respectfully, in the industry and one (1) character reference in the space provided below. Please note that the reference letters must correspond with the names listed below and should be persons other than Board Members and relatives of the applicant. Name Address Telephone # 1. 2. 3. Part IV 19. EDUCATION/TECHNICAL TRAINING: (Please list in chronological order beginning with most recent) Name & Address of Institution Attendance From To Technical Course Graduation Degree Received 20. EMPLOYMENT/EXPERIENCE: (Please list in chronological order your plumbing experience for the past 5 years. Use an additional sheet if necessary, following the same format or attach a resume.) From To Name, Address & Phone # of Employer Name of Immediate Supervisor Job Title and Description *All information must be verifiable. Any false information may be reason for denial of application. Part V AFFIDAVIT (Must be completed by all applicants) State of ________________________________ Territory of ________________________________ Country of ________________________________ I, ________________________________, being duly sworn, depose and say that I am the person who executed the foregoing instrument; that I have read the same and know the contents thereof; that the matters stated therein are true to my knowledge; that I have not suppressed any information that might affect this application; and that I have read and understand this affidavit. ______________________________ Applicant's Signature Sworn and Subscribed before me this __________ day of __________________, 20 __________ ______________________________ Notary Public My Commission expires on _______ Do not write below this line: BOARD DISPOSITION: Application Approved: ( ) YES ( ) NO _______________________________ _______________________________ Signature, Chairman of the Board Date _______________________________ _______________________________ Member Member _______________________________ _______________________________ Member Member EXAM AND LICENSURE REQUIREMENTS APPLICANT FOR EXAMINATION 1. Must be a resident of the Virgin Islands for at least 30 days immediately prior to submitting application for examination. 2. Must submit 2 letters of professional reference from persons with knowledge of applicant's work in the field specified and 1 letter of favorable character testimony. 3. Provide evidence of at least 5 years’ experience in the specified trade. 4. Copy of current registration/licensure. 5. Copy of Certification from Trade School (if applicable). 6. Application fee of $25.00. * All applicants will be required to sit both a written and practical examination. APPLICATION FOR LICENSURE Upon successful completion of the examination, applicant must select the licensure he/she wishes to pursue. An applicant for a Master Plumber or Master Mechanic (HVAV) License must provide to the Board the following: 1. Completed business license application approved by DPNR, VIFS & VIPD. 2. Certificate of Trade Name Registration (If applicable). 3. Letter from a financial institution stating the applicant is in good standing. 4. License fee of $130.00, which covers licensure for one (1) year from date of issuance. * A holder of a Master Plumber's or Master Mechanic’s License shall not employ more than one full or part-time apprentice or journeyman. An applicant for a Plumbing Contractor or Air Conditioning/Refrigeration Contractor License must provide to the Board the following: 1. Completed business application approved by DPNR, FIRE & POLICE. 2. Employer Identification Number (EIN). 3. Certificate of Trade Name Registration (if applicable). 4. Letter from a financial institution stating the applicant is in good standing. 5. Proof of Public Liability Insurance. 6. Workman's Compensation Insurance (if applicable). 7. License fee of $130.00, which covers licensure for one (1) year from date of issuance. Notice: Title 27 V.I.C. § 275 "Whoever violates or refuses to comply with any provisions of this chapter or any rule or regulation thereunder shall be fined not more than $500.00 for each and every violation or act of non-compliance."