Certification Of Work Experience {13A-11}

13A-11 - CERTIFICATION OF WORK EXPERIENCE. • This form must be filled in completely in order to document applicant’s work experience, or the application will be returned for correction or completion. The qualifying individual on the application (as listed on Page 1 of the application) and certifier (a qualified and responsible person who verifies the experience in the classification for which the applicant is seeking licensure) must type or print neatly and legibly in black or dark blue ink - pencil is not acceptable. • FORMS CONTAINING STRIKEOUTS OR MODIFICATIONS MAY NOT BE ACCEPTED. • Corrections on the Certification of Work Experience forms must be initialed by the certifier. • Original signatures are required - faxed, photocopied, or stamped signatures are not acceptable. • All qualifying individuals and certifiers must be at least 18 years old. • All Certification of Work Experience forms must be submitted with the application. • The Certification of Work Experience form, when filed with an application, becomes the property of CSLB and is kept as a matter of record. Keep a copy of the completed and signed form for your records - you may be asked to provide further documentation or testimony to verify your experience. A random three percent (3%) of applications are subject to review, and experience must be verifiable through payroll records and similar documents. CSLB staff may contact the certifier or other parties to verify experience. • If you have ever served as a qualifier on a license in the classification for which you are now applying, you may not need to complete this form. However, if you are applying for a waiver of the examination pursuant to Business and Professions Code (BPC) sections 7065.1(b) or 7065.1(c), you do need to complete this form. (Please refer to CSLB’s website for more information on exam waivers.) NOTE: If you had a previous application that was denied on the basis of a lack of qualifying work experience, you must complete this form, regardless of whether or not you passed the examination. • Anyone who knowingly procures or offers false or forged documents to be filed, registered, or recorded in any public office in California is guilty of a felony. (Penal Code section 115) www.FormsWorkflow.com