Styleposition Absolute Top 002in Left 375in VERIFICATION OF CONSTRUCTION

style=position: absolute; top: -0.02in; left: 3.75in verification of construction experience all information is to be typed or printe

style="position: absolute; top: -0.02in; left: 3.75in"
VERIFICATION OF CONSTRUCTION EXPERIENCE
ALL INFORMATION IS TO BE TYPED OR PRINTED
ILLEGIBLE APPLICATIONS WILL NOT BE ACCEPTED AND WILL BE RETURNED
INFORMATION HEREON MUST BE ORIGINAL – NO COPIES OR FAXES
Hillsborough County Contractor Licensing Date:
____________________________________
----------------------------------------------
601 E. Kennedy Boulevard, 19th Floor
====================================
P.O. Box 1110
Tampa, Florida 33601
====================
In Reference To:_____________________________________________________________________________________
NAME OF APPLICANT: FIRST NAME MIDDLE INITIAL LAST NAME SR, JR, I, II,
etc.
I, ____________________________________________________, license
number_________________________________
FULL NAME OF LICENSE HOLDER CONTRACTOR LICENSE or CERTIFICATE #
licensed in
____________________________________________________,hereby certify
that I personally have knowledge
JURISDICTION IN WHICH LICENSE WAS ISSUED
that ________________________________________________has a total of
_____________hours HANDS-ON experience
NAME OF APPLICANT ACTUAL HOURS
and a total of ____________hours (if applicable) as a
foreman/supervisor performing the work described below,
ACTUAL HOURS
having performed said work between ____________________ to
____________________. >
MONTH/YEAR MONTH/YEAR
DO NOT COMBINE HANDS-ON HOURS WITH SUPERVISORY HOURS.
In your own words describe what you know of the applicant’s
experience. Describe the type of hands-on work he/she performed.
Describe the kind of buildings, structures, or projects worked upon.
Give any details that might aid in evaluating his/her experience.
Attach additional page(s) as necessary. .
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________
Notary Public
=============
STATE OF __________________________________________
===================================================
COUNTY OF ________________________________________
Sworn to (or affirmed) and subscribed before me this
___________, day of _________________________, 20_______
by __________________________________________________
(Printed/Typed Name of License Holder Making Statement)
Personally Known _______ to me OR Produced Identification
____________________________________________________
(Type of Identification Produced)
____________________________________________
============================================
(Signature of Notary)
My Commission expires:________________________________
____________________________________________
SIGNATURE OF LICENSE HOLDER ATTESTING TO WORK
________________________________________
Printed Name of License Holder
________________________________________
CONTACT PHONE NUMBER W/ AREA CODE
Affix Notary
Seal
NOTE: If applicant is self-employed, notarized letters from Building
Officials, licensing agencies, and/or contractors you performed work
for will be accepted. This form may be duplicated. Verification forms
must be furnished to substantiate the minimum experience in the
category for which application is made.
11/14/2021