Section 4 - Additional Personnel

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    Easy-Fill Form

    The following must be completed by all individuals and companies that will be listed on the license. You must provide full legal names of all individuals. Each individual must sign the certification statement under penalty of perjury. (See Section 4 of the General Information and Instructions regarding company personnel.)

    This is an Easy-Fill form that will walk you through the process to fully and accurately complete this form. Upon completion, you will be required to print and submit the document to CSLB.

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    9A. PERSONNEL 1

    BUSINESS ENTITY

    *BUSINESS WILL OPERATE AS A:



    PERSONNEL FULL LEGAL NAME AND ADDRESS

    If this personnel is a company, enter the company name in the first name field and enter "n/a" in fields that do not apply to companies (i.e., middle and last names, date of birth, driver license number, and Social Security number or ITIN).

    *RESIDENCE ADDRESS
    Must be hand written on form
    *TITLE OR POSITION:





    * Required Entry
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    9B. PERSONNEL 2

    PERSONNEL FULL LEGAL NAME AND ADDRESS

    *RESIDENCE ADDRESS
    Must be hand written on form
    *Title or Position:




    * Required Entry
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    9C. PERSONNEL 3

    PERSONNEL FULL LEGAL NAME AND ADDRESS

    *RESIDENCE ADDRESS
    Must be hand written on form
    *Title or Position:




    * Required Entry
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    9D. PERSONNEL 4

    PERSONNEL FULL LEGAL NAME AND ADDRESS

    *RESIDENCE ADDRESS
    Must be hand written on form
    *Title or Position:




    * Required Entry
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    Review and Edit

    Please Review the Following Information

    This is a summary of the information that will print on your form. If there are any corrections that need to be made, please choose the Edit button or Back button below to make the change now, as you will not have the opportunity to do so after you submit this page.

    RESIDENCE ADDRESS

    RESIDENCE ADDRESS

    RESIDENCE ADDRESS

    RESIDENCE ADDRESS


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    Completion Instructions

    NOTICE: This document is not submitted to or saved by CSLB. You must either print it now, save it to your computer, or email it to your email address to print and mail at a later time.


    Mail your document(s) along with the application to:

    Contractors State License Board
     P. O. Box 26000
     Sacramento, CA 95826

    PDF

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