Commonwealth of Virginia
Department of Professional and Occupational Regulation
9960 Mayland Drive, Suite 400
Richmond, Virginia 23233-1485
(804) 367-8511
www.dpor.virginia.gov
Board for Contractors
LICENSE APPLICATION
OFFICE
USE
ONLY
DATE FEE TRANS CODE ENTITY # FILE #/LICENSE # ISSUE DATE
2705
BOARD
USE
ONLY
SCC ETS CLASS A CLASS B VIRGINIA TECHNICAL
A501-27LIC-v14 Board for Contractors/LIC APP
02/24/2022 Page 1 of 6
A check or money order payable to the TREASURER OF VIRGINIA,
or a completed credit card insert must be mailed with your application package.
APPLICATION FEES ARE NOT REFUNDABLE.
FINANCIAL REQUIREMENTS:
Class A & Class B Applicants must provide proof of financial responsibility. Class A applicants must document $45,000 in net worth/equity. Class B
applicants must document $15,000 in net worth/equity. Applicants who do not meet these requirements may qualify for a Class C license.
Select the one license type you are requesting.
* License fee may be adjusted per designation selection. (See question #12.A.)
Type of
License
X
Trans
Code
Initial
License Fee*
Financial Documentation
Included (select only one)
Class A 1022 $385.00
Class B 1021 $370.00
Class C 1020 $235.00
N/A
Financial Statement Form
Surety Bond Form
CPA review/audit
1.
Business Entity/Sole Proprietor Name
A sole proprietor should enter his/her full legal name and the company name should be entered below as the assumed/fictitious name.
All names must be the same as displayed on government issued ID or organization/business documents.
2.
Assumed or Fictitious Name
If an assumed/fictitious name is to be used, a copy of the certificate filed with the Virginia State Corporation Commission (SCC) pursuant to
§59.1-69 of the Code of Virginia must be attached to this application.
3. A. Type of business entity (select only one)
Sole Proprietorship
General Partnership
Solely Owned LLC
Corporation
Limited Partnership Limited Liability Company Other, please specify:
Other: Association, Business Trust, Government Agency, Joint Venture, Limited Liability Partnership, Non Profit, Professional Corporation, or
Professional Limited Liability Company.
B.
State Corporation Commission (SCC) Number:
(If applicable)
All businesses in Virginia must be registered with the SCC (including all out-of-state businesses). Firms/Businesses shall be organized as
business entity under the laws of the Commonwealth of Virginia or otherwise authorized to transact business in Virginia. No person,
partnership, limited liability company or corporation shall conduct or transact business in this Commonwealth under any assumed or
fictitious name unless register with the Virginia SCC.
For additional information, contact the SCC at www.scc.virginia.gov or by phone at (804) 371-9733.
4. Provide one of the following identification numbers:
Business Federal Employer Identification Number (EIN)
Sole Proprietor's/Individual's Social Security Number and/or
Virginia Department of Motor Vehicles Control Number
Federal Employer Identification Number (12-3456789)
-
- -
Social Security or Virginia DMV Number (123-45-6789)
Enter the same identification number as used on previous applications or licenses on file with the department.
State law requires every applicant, who is not a sole proprietor or solely owned LLC, to provide a federal employer identification number. Sole proprietor or
solely owned LLC who do not have a FEIN must provide a social security number or a control number issued by the Virginia Department of Motor Vehicles.
A501-27LIC-v14 Board for Contractors/LIC APP
02/24/2022 Page 2 of 6
5.
The mailing address will be
printed on the license.
Mailing Address (PO Box accepted)
City State Zip Code
6. Street Address (PO Box not accepted)
PHYSICAL ADDRESS REQUIRED
Check here if Street Address is the same as the Mailing Address listed above.
State City Zip Code
7. Contact Numbers
Primary Telephone Alternate Telephone Fax
Email Address
Email address is considered a public record and will be disclosed upon request from a third party.
8.
9. Does your Business, Designated Employee, Qualified Individual(s) or Responsible Management have a current
or expired contractor's license, certification or registration from any jurisdiction (outside of Virginia)?
No
Yes
If yes, complete the following table.
Business/Individual Full
Legal Name
State/
Jurisdiction
License, Certification or
Registration Number
Expiration Date
10.
List all Responsible Management (sole proprietor, partners of a general partnership, managing partner of a limited
partnership, officers/directors of an association, managers/members of a limited liability company, or officers of a
corporation):
Individual's Full Legal Name Title Address
Social Security No. or
VA DMV Control No.*
Date of
Birth
Required Documentation: Must attach a legible copy of a government issued photo ID for all
members of Responsible Management.
11. All business entities applying for a license are required to have a Designated Employee or a member of Responsible
Management complete a board approved pre-license education course approved by the Board of Contractors. Enter
the following information for the individual who has successfully completed this requirement.
Full Name Date of Birth
Provide either Social Security No. or VA DMV Control No. :
Social Security or Virginia DMV Number (123-45-6789)
--
Course Date Completed
MM/DD/YYYY
Provider Name
NOTE: Completion of this course cannot be used to substitute the business exams taken by the Designated Employee or
Qualified Individual.
Required Documentation: Must attach a legible copy of a government issued photo ID for the Designated Employee (if
applicable).
A501-27LIC-v14 Board for Contractors/LIC APP
02/24/2022 Page 3 of 6
Below is a chart listing the license classifications and specialty designations issued by the Virginia Board for
Contractors. A definition of the type of work that each of these classifications and designations may perform is
available in the Board for Contractors Regulations.
12.
Each business will select a classification/specialty designation for which they are applying for and provide one
Qualified Individual for each designation in section A or B below. The Qualified Individual must meet the following
criteria:
Must have the minimum years of experience in the classification or specialty they are applying - 2 years for a Class C License, 3 years for
a Class B License and 5 years for a Class A License. An Experience Verification Form must be submitted for each Qualified Individual
who is requesting a designation that requires pre-approval for an examination.
2.
Must be either a fulltime employee of the business (working a minimum of 30 hours or more with the business) or who is listed as a
member of Responsible Management.
1.
Have successfully completed the appropriate prerequisite for the classification or specialty designation selected below. The prerequisite
for each is listed in the box below. For more information on these please see the Requirements for the Qualified Individual Form.
3.
License Classifications and Specialty Designations
Applicants must hold a Certification for the following classification and/or specialty:
BEC Blast/explosive
SPR Fire sprinkler
MHC Manufactured home contracting RMC Radon mitigation
Applicants must hold a valid license issued from DPOR for the following designation:
ADS Alternative Disposal System
ASB Asbestos
Accessibility ServicesASC
Accessibility Services with LULAASL
Conventional Disposal SystemCDS
ELE Electrical
EEC Elevator/escalator
GFC Gas fitting
HVA HVAC
LAC Lead abatement
LPG Liquefied petroleum gas
NGF Natural gas fitting provider
PLB Plumbing
WWP Water well/pump
* Applicants are required to be pre-approved and pass an examination for the following classification and/or specialty:
AES Alternative energy systems
PAV Asphalt paving & seal coating
BSC Billboard/sign
CBC Commercial Building
CIC Commercial improvement
CEM Concrete
DRY Drywall Company
ESC Electronic/communication service
EMW Environmental monitoring well
ENV Environmental specialties
EMC Equipment/machinery
FIC Farm improvement
FIN Finish Carpentry Contracting
FAS Fire alarm systems
FSP Fire suppression
FLR Flooring & Floor Cover'g Contracting
FRM Framing Sub Contractor
H/H Highway/heavy
HIC Home Improvement
IBC Industrial building contracting
ISC Landscape irrigation
LSC Landscape services
MCC Marine facility
BRK Masonry
PTC Painting & wall covering
RBC Residential Building
REF Refrigeration
RFC Recreational facility
ROC Roofing
POL Swimming pool construction
VCC Vessel construction
GLZ Glass & Glazing Contracting
INS
Insulation & Weather Stripping
Contracting
STL Steel Erection Contracting
TMC
Tile, Marble, Ceramic
& Terrazzo Contracting
UUC
Underground Utility
& Excavating Contracting
* All qualified individuals must submit an Experience Verification Form for these designations.
DLR Drug, Lab, Remediation
Applicants are required to receive special approval by the Board for the following specialty:
MSC Miscellaneous Contracting
Are you applying for a Commercial Building Contractor (CBC) classification, and/or a Commercial improvement (CIC)
specialty; with no other classification/specialty requested for this license?
A.
No
Yes If yes, complete the following table*: (Do not complete question #12.B.)
If no, complete section 12.B.
* Modification to your application fee is as follows:
** Contractor's Recovery fund fee is not required for CBC/CIC only.
Class A: $360.00** Class B: $345.00** Class C: $210.00**
Select
3-letter
Code
Last Name First Name MI
Years of
Exp
.
Exam
Date
Social Security No. or
VA DMV Control No. *
VA Qualifying
License No.
(if applicable)
Birth
Date
CBC
CIC
Required Attachment: Complete an Experience Verification Form for each Qualified Individual listed in this table.
A501-27LIC-v14 Board for Contractors/LIC APP
02/24/2022 Page 4 of 6
If you answered "no" in Section A, select all the license classification and specialty designations you are requesting for
this license:
(This section can include CBC/CIC designation, but only if your request includes other classification/specialties. There is no fee reduction to
your application fee. Contractor's Recovery fund fee is required for all other classification/specialty designations.)
B.
3-letter
Code
Last Name First Name MI
Years of
Exp.
Exam
Date
Social Security No. or
VA DMV Control No.*
VA Qualifying
License No.
(if applicable)
Birth
Date
Any business requesting a license may have more than one classification or specialty designation.
Required Attachment: Complete an Experience Verification Form for each Qualified Individual who is seeking pre-approval for a
designation that requires an examination (only). IF applying for the MSC specialty, provide the Board for Contractors with all required
documentation to support your request for this designation.
13.
All Class C applicants, skip to question #14.
All Class A & Class B license applicants must declare a Designated Employee who has successfully completed the
appropriate business examinations and is either a full-time employee (not a 1099 employee) of the business or a
member of Responsible Management. For licensure information, contact the Board for Contractor's by phone at
804-367-8511 or email at [email protected].
Complete the following information for the Designated Employee of this business:
Required examinations per class: Class A - Advanced, General, and Virginia exam; and Class B - General and Virginia
exam.
Full Name Date of Birth
Required Documentation: If the Designated Employee is not a member of Responsible Management, attach a legible copy of
a government issued photo ID and provide fulltime employment verification (I9, W2, or other similar documentation).
Provide either Social Security No. or VA DMV Control No. :
Social Security or Virginia DMV Number (123-45-6789)
--
Exam Date
14.
Has this Business, Designated Employee, Qualified Individual(s) or Responsible Management ever been subject
to a disciplinary action taken by any (including Virginia) local, state or national regulatory body?
No
Yes If yes, complete the Disciplinary Action Reporting Form.
A. Has this Business, Designated Employee, Qualified Individual(s) or Responsible Management ever been
convicted or found guilty, regardless of the manner of adjudication, in any jurisdiction of the United States of any
felony? Any plea of nolo contendere shall be considered a conviction.
No
Yes
15.
If yes, complete the Criminal Conviction Reporting Form.
B.
No
Yes
Has this Business, Designated Employee, Qualified Individual(s) or Responsible Management been
convicted or found guilty, regardless of the manner of adjudication, in any jurisdiction of the United States of any
non-marijuana misdemeanor within the last 3 years? Any plea of nolo contendere shall be considered a
conviction.
If yes, complete the Criminal Conviction Reporting Form.
A501-27LIC-v14 Board for Contractors/LIC APP
02/24/2022 Page 5 of 6
During the past five years, has any member of Responsible Management had any outstanding/past-due debts
(including child support arrearage); judgments; liens; past due 'unpaid' claims or suits; outstanding tax obligations;
defaults on bonds; or pending/past bankruptcies?
16.
No
Yes If yes, complete the Adverse Financial History Reporting Form.
17. Do all members of Responsible Management understand that all Class A, Class B and Class C Contractors must
comply with the local licensing requirements of all counties, cities and towns in which work is performed?
No
Yes
IF NO, THIS APPLICATION CANNOT BE PROCESSED.
18. Class A & Class B applicants only:
No
Yes
If yes, the firm is required to submit a complete (a) Financial Statement Form, (b) CPA review/audit, OR
(c) Surety Bond Form with this application.
Does this business/firm meet the minimum net worth/equity requirements? (At least $15,000 for Class B applicants or
$45,000 for Class A)
If no, the firm may qualify for a Class C license.
By signing this application, you acknowledge that if you are not a Virginia resident, or move outside of Virginia while you hold
a Virginia Contractors License, you understand that this application serves as a written power of attorney, whereby you
appoint the Director of the Department of Professional and Occupational Regulation, and his/her successors in office, to be
your true and lawful agency and attorney-in-fact, in your stead, upon whom all legal process against and notice to you may be
served and who is hereby authorized to enter an appearance on your behalf in any case or proceedings arising out of the
trade or profession practiced; and that by submitting this application, you hereby agree that any lawful process against you
which is duly served on said agent and attorney-in-fact shall be of the same legal force and validity as if served upon you.
19. By signing this application, I certify the following statements:
I am aware that submitting false information or omitting pertinent or material information in connection with this
application will delay processing and may lead to license revocation or denial of license.
I will notify the Board of any changes to the information provided in this application prior to receiving the
requested license, certification, or registration including, but not limited to any disciplinary action or conviction of
a felony or misdemeanor (in any jurisdiction).
I authorize the Department to verify information concerning me or any statement in this application from any
person, or any source the department may desire. I also agree to present any credentials or documents
required or requested by the Department.
I authorize any federal, state or local government agency, current or former employer, or other individual or
business to release information which may be required for a background investigation.
I have read, understand and complied with all the laws of Virginia related to this profession under the provisions
of Title 54.1, Chapter 11, of the Code of Virginia and the Virginia Board for Contractors Regulations.
●
Signature(s) of all members of Responsible Management (required):
(sole proprietor, partners of a general partnership, managing partner of a limited partnership, officers/directors of an association,
managers/members of a limited liability company, or officers of a corporation)
I certify that I am a member of responsible management as defined in 18VAC50-22-10 of the Board for
Contractors regulations and am authorized to bind the applicant to contracts and other legal obligations.
1.
Print Name Title
Signature Date
2.
Print Name Title
Signature Date
A501-27LIC-v14 Board for Contractors/LIC APP
02/24/2022 Page 6 of 6
3.
Print Name Title
Signature Date
4
.
Print Name Title
Signature Date
(Photocopy this sheet if additional signatures are needed.)
Signature of Designated Employee: (Who are listed on this application and not a member of Responsible
Management)
1.
Print Name Title
Signature Date
Signature(s) of Qualified Individual: (Who are listed on this application and not a member of Responsible
Management)
1.
Print Name Title
Signature Date
2
.
Print Name Title
Signature Date
(Photocopy this sheet if additional signatures are needed.)
ATTACHMENTS: (Check all attachments/documentation included with this application)
Attach a copy of Government Issued Photo IDs for each member of Responsible Management, Designated Employee, and all Qualified
Individuals listed on this application. (Photo must be legible)
All businesses with an assumed/fictitious name must attach a copy of the certificate filed with the Virginia State Corporation Commission (SCC)
pursuant to §59.1-69 of the Code of Virginia. - question #2
Any Designated Employee or Qualified Individual listed on this application must submit verification of employment (I9, W2 or others) if
not a member of Responsible Management.
Attached documentation verifying business FEIN number - question #4
Completed the Pre-License Education Course taken by Designated Employee or member of Responsible Management - question #11
Qualified Individual(s) must attach a copy of any certifications - if required - question #12.B.
Experience Verification Form completed for each Qualified Individual who is seeking pre-approval for an examination (only) per the
designation requested - questions #12.A or 12.B
All required documentation to support the special request for the Miscellaneous Contracting (MSC) designations shall be submitted with
this application package. This specialty is limited to a single activity and will be restricted to that specialty only - question #12.B
Designated Employee completed the business examination? - question #13
All disclosure forms and supporting documentation - questions #14-16
All applicants for Class A or Class B license types must submit ONE of the following: (a) Financial Statement Form, (b) CPA review/audit
OR (c) Surety Bond Form. - question #18
