LIC42 Practical Examination Application
Rev. 1/18 The New York State Executive Law prohibits discrimination on the basis of age, race, creed, color, sexual orientation, national origin, military status, sex, marital status, or disability. Zip: Telephone Number: LIC42 Practical Examination Application ( Application must be typewritten) DATE: 1 Applicant Information. Required for all applicants. Choose One: Last Name: First Name: MI: Mailing Address: City: State: **Social Security Number: Date of Birth (MM/DD/YY) *Email Address: Stationary Engineer Master Rigger Tower/Climber Crane Rigger Special Rigger Master Plumber Master Electrician Special Electrician Master Sign Hanger Special Sign Hanger Application FILING INSTRUCTIONS SUBMISSION: The below items must be properly completed, signed, and sent by mail with the exam fee to: NYC Department of Buildings Licensing & Exams Unit 280 Broadway, 6th Floor New York, NY 10007 Remember to include: 1.
Rev. 1/18. The New York State Executive Law prohibits discrimination on the basis of age, race, creed, color, sexual orientation, national origin, military status, sex, marital status, or …
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