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Apprentice Plumber Gas Fitter

Apprentice Registration Form Instructions Step 1 / 6

Application for registration as an Apprentice Plumber/Gas Fitter is hereby made and the fee of $35.00 is hereby submitted in the form of ELECTRONIC CHECK or CREDIT CARD.

NOTE: Please print or type and provide all requested information. A home address MUST be provided even if you receive your mail at a different address.

Demographics Step 2 / 6

Last Name

First Name

Middle Initial

Suffix

Social Security Number

Are you a U.S. Citizen?

Yes

Home Address

Address1

Address2

County

City

State

Zip

Home Phone Number

Home Email

Mailing Address

Check if mailing address is the same as above.

Mailing Address1

Mailing Address2

Mailing County

Mailing City

Mailing State

Mailing Zip

Phone Number

Employment Step 3 / 6

I do not have an employer

Please provide the following information. If not currently employed, leave this section blank or write "N/A". Any changes in residence or employment must be submitted to the Board in writing within 30 days of the change in compliance with Ala. Code $34-37-14(a).

Employer Name

Employer's Address1

Employer's Address2

Employer's City

Employer's State

Employer's Zip

Employer's Phone Number

Employer's Email

Citizenship Step 4 / 6

CITIZENSHIP This section to be completed in compliance with Ala. Code § 34-14A-7 and Ala. Code § 31-13-7.

I declare under penalty of perjury, under the laws of the State of Alabama that all statements contained in this application, and any accompanying documents, is true and correct, with full knowledge that all statements made in this application are subject to investigation and that any false or dishonest answer to any question may be grounds for denial or subsequent revocation of my license or application.

Are you a citizen of the United States?

Yes

I hereby declare that I am a citizen of the United States of America and, I sign this declaration under penalties of perjury; making a false, fictitious, or fraudulent statement or representation in this declaration is perjury in the second degree pursuant to Ala. Code § 13A-10-102.

PROVIDE PROOF OF CITIZENSHIP i.e.: driver’s license, passport, birth certificate

Signature of Applicant

Date

Preview Page Step 5 / 6

Please review Prior to Submission. Corrections can be made by clicking on "PREVIOUS" button at the bottom.

Affrim And Submit Step 6 / 6

Applicant's Signature

Date

All fees (including Convenience fee) are non-refundable

Fee

Convenience fee

Total

Payment Type

Person's Name on Card

Card Type

Card Number

Expiration Date (MM/YY)

Security Code

Zip code

Board charge, including a convenience fee, will appear on your statement with a description including IGOVSOL*