The Kentucky Elevator Mechanic License form is an official document required for individuals seeking to work as elevator mechanics in the state of Kentucky. This application process ensures that candidates meet the necessary qualifications and standards for safely maintaining and installing elevators. By completing this form, applicants take a significant step toward obtaining their professional license and contributing to public safety in the field of elevator operations.
The Kentucky Elevator Mechanic License application serves as a critical gateway for individuals seeking to work as elevator mechanics in the Commonwealth. This form, issued by the Department of Housing, Buildings and Construction, requires applicants to provide comprehensive personal and professional information. Essential details include the applicant's name, address, and contact information, alongside their current employer's details. A significant component of the application is the section dedicated to documenting elevator experience, which may encompass education, training, and work history. Applicants must attach a recent passport-sized photograph and submit relevant documentation to verify their experience, such as tax records or proof of training programs. Additionally, the form mandates an initial application fee, which varies based on the applicant's birth month and the month of application. This fee structure ensures that applicants are aware of the financial commitments involved. Furthermore, the application process includes an acknowledgment of any previous licenses held and a declaration regarding student loan status, emphasizing the importance of compliance with financial obligations. Overall, the Kentucky Elevator Mechanic License application not only facilitates the licensing process but also underscores the standards and regulations governing the profession.
COMMONWEALTH OF KENTUCKY
Public Protection Cabinet
Department of Housing, Buildings and Construction
DIVISION OF BUILDING CODES ENFORCEMENT
ELEVATOR SECTION
101 Sea Hero Road, Suite 100
Frankfort, Kentucky 40601-5405
Telephone: 502-573-1694 Fax: 502-573-1059
ELEVATOR MECHANIC LICENSE APPLICATION
Please type or print application. Answer all questions on both sides of this application.
An application fee is to be submitted payable to Kentucky State Treasurer.
1.
Name: _________________________________________________________________
Attach a recent
Last
First
MI
passport- sized, color
Address: _______________________________________________________________
photograph of applicant
(Street, Route or Box Number)
here.
City:
State:
Zip: __________
County:
Telephone: (
)
-_________
Date of Birth:
/
Email address: __________________________
2.Current Employer or Company Name: ______________________________________
Address:
___________________________________________________________________________________________
Zip: _______________
County:_____________________________________________
- __________
Federal ID Number (Business) ____________________________________________
3. Elevator Experience History: Education, Training or Apprenticeship Program
*Use additional sheets, if necessary. Begin with most recent work, education or training experience.
Name of Company/School/Apprenticeship Program: _______________________________________________________
Address: ___________________________________________________________________________________________
Dates of Attendance:
From ____/____/____ To ____/____/____
Type of Elevator Work/Training ________________________________________________________________________
____________________________________________________________________________________________________
Form EV-4 (Orig. 9-11)
4. Have you previously held a Elevator Mechanic’s license in the Commonwealth of Kentucky?
Yes
No
If yes, list license number and date you were first licensed. (Attach copy of license, if available)
License Number: _______________ Date: ________________
The commissioner, in accordance with KRS Chapter 13B, may refuse to issue, suspend, revoke, or refuse to renew the license or certificate of any licensee or certificate holder pursuant to KRS 198B.4033.
Please fill in each circle acknowledging that you have included the following:
O Completed Application and required supplemental documentation (valid for one year from date of receipt)
O An initial application fee (submitted to the Department and payable to Kentucky State Treasurer).
_____ (Initial) I am not in default of any student loans backed by the KHEAA (Kentucky Higher Education Assistance
Authority). I understand that if I am in default of any student loans backed by the KHEAA, I cannot receive a Kentucky Elevator Mechanic license at this time.
______(Initial) I confirm that all information contained on and submitted with this application is current and true to the best
of my knowledge.
Applicant’s Signature: _______________________________________________________ Date:___________________
COUNTY OF_____________________
The applicant, whose name is,
, being duly sworn declares that foregoing
subscribed statements are true to the best of their knowledge and belief, and that they have personally signed this application.
Subscribed and sworn to before me thisday of_________________, _______
Notary Public ______________________________
My Commission expires: ______________________
For Office Use Only
Date Received_____________________
Approved ________________________
Issue ____________________________
Pending __________________________
Board Review _____________________
Elevator Mechanic # ________________
Issue & Status _____________________
EV-4 (Orig. 9-11)
Read this section carefully!
The following information shall be submitted with application:
One Passport sized photograph taken within 3 months of application.
Documentation for verification of experience. (i.e. official Tax documents, copies of business licenses, sworn affidavit attesting to your experience or any other valid documentation of experience). For a complete list of documentation examples, go online to http://dhbc.ky.gov.
If applicable for proof of experience, Mechanic license applicants shall provide a copy of certificate of completion of nationally recognized training program, apprenticeship program or apprenticeship registration.
Proof of passage of written, oral, or computerized examination if applying pursuant to KRS 198B.4013(2)(a).
Passage of a written, oral, or computerized examination administered by the department based upon the most recent referenced codes and standards
Annual Fee for Elevator Mechanic License $96 ($8 per month)
A nonrefundable fee must be submitted with this application. Without this fee, this application will not be processed.
License shall be pro-rated for initial activation. The Division shall issue a license for no less than 7 months and no more than 18 months, based upon your birth month and time of application.
Mail checks only.
Credit card payments are available online.
Make checks payable to Kentucky State Treasurer.
Elevator Mechanic License
Initial Fee Chart
Use the chart below to determine the correct fee for application. The fee is based on your birth month and the month which you are applying. Add the fees if you are applying for multiple licenses.
Example: If you were born in October and you are applying in July, then the Elevator Mechanic application fee is $120. This license would be valid for 15 months. Each time you renew your license after your initial activation, your license will be valid for one year and will be subject to annual renewal in October (your birth month).
Birth Month
Month you are Applying
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
$96.00
$88.00
$80.00
$72.00
$64.00
$56.00
$144.00
$136.00
$128.00
$120.00
$112.00
$104.00
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