Form DBPR MRS0701 "Application for Licensure" - Florida

What Is Form DBPR MRS0701?

This is a legal form that was released by the Florida Department of Business & Professional Regulation - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2015;
  • The latest edition provided by the Florida Department of Business & Professional Regulation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DBPR MRS0701 by clicking the link below or browse more documents and templates provided by the Florida Department of Business & Professional Regulation.

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Download Form DBPR MRS0701 "Application for Licensure" - Florida

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State of Florida
Department of Business and Professional Regulation
Mold Related Services
Application for Licensure
Form # DBPR MRS 0701
APPLICATION CHECKLIST – IMPORTANT – Submit all items on the checklist below with your
application to ensure faster processing.
APPLICATION
APPLICATION REQUIREMENTS
 Fee of $230 if applying for an initial active or inactive license. Make check
payable to the Florida Department of Business and Professional
Regulation.
 Complete Sections I-IV, VI and VIII.
 Pass the state required examination.
 Submit proof of education (transcripts).
Licensure by
 Complete set of electronic fingerprints as required pursuant to Rule 61-
Examination
31.101(2)(d), F.A.C.
 Supporting legal documentation (if applicable). See Section “c” of
Application Instructions.
 Submit proof of documented training in water intrusion, mold and
respiratory protection.
 Fee of $230 if applying for an initial active or inactive license. Make check
payable to the Florida Department of Business and Professional
Regulation.
 Complete Sections I-III, V, VI and VIII of this application OR complete
Sections I - VII if you have passed a state or national exam but do not hold
an out of state license.
 Submit certificate of licensure from a state or national association with
Licensure by
equivalent educational and experience requirements as this state.
Endorsement
 Complete set of electronic fingerprints as required pursuant to Rule 61-
31.101(2)(d), F.A.C.
 Supporting legal documentation (if applicable). See Section “c” of
Application Instructions.
 Submit proof of documented training in water intrusion, mold and
respiratory protection.
Pay fee of $230, payable to the Department of Business and Professional
Regulation.
Complete Sections, I, II, III and VI-VIII of this application.
Supporting legal documentation (if applicable). See Section of 1(c) of the
instructions.
Reinstatement of Null
Provide an explanation of the illness or economic hardship that prevented
and Void License
renewal of your license.
Proof of completion of continuing education required for renewal: 14 hours.
Complete set of electronic fingerprints as required pursuant to Rule 61-
31.101(2)(d), F.A.C.
Please mail your completed application, documentation and required fee(s) to:
Department of Business and Professional Regulation
2601 Blair Stone Road
Tallahassee, FL 32399-0783
DBPR MRS 0701- Application for Licensure
September 2015
Incorporated by Rule: 61-31.101
1 of 11
State of Florida
Department of Business and Professional Regulation
Mold Related Services
Application for Licensure
Form # DBPR MRS 0701
APPLICATION CHECKLIST – IMPORTANT – Submit all items on the checklist below with your
application to ensure faster processing.
APPLICATION
APPLICATION REQUIREMENTS
 Fee of $230 if applying for an initial active or inactive license. Make check
payable to the Florida Department of Business and Professional
Regulation.
 Complete Sections I-IV, VI and VIII.
 Pass the state required examination.
 Submit proof of education (transcripts).
Licensure by
 Complete set of electronic fingerprints as required pursuant to Rule 61-
Examination
31.101(2)(d), F.A.C.
 Supporting legal documentation (if applicable). See Section “c” of
Application Instructions.
 Submit proof of documented training in water intrusion, mold and
respiratory protection.
 Fee of $230 if applying for an initial active or inactive license. Make check
payable to the Florida Department of Business and Professional
Regulation.
 Complete Sections I-III, V, VI and VIII of this application OR complete
Sections I - VII if you have passed a state or national exam but do not hold
an out of state license.
 Submit certificate of licensure from a state or national association with
Licensure by
equivalent educational and experience requirements as this state.
Endorsement
 Complete set of electronic fingerprints as required pursuant to Rule 61-
31.101(2)(d), F.A.C.
 Supporting legal documentation (if applicable). See Section “c” of
Application Instructions.
 Submit proof of documented training in water intrusion, mold and
respiratory protection.
Pay fee of $230, payable to the Department of Business and Professional
Regulation.
Complete Sections, I, II, III and VI-VIII of this application.
Supporting legal documentation (if applicable). See Section of 1(c) of the
instructions.
Reinstatement of Null
Provide an explanation of the illness or economic hardship that prevented
and Void License
renewal of your license.
Proof of completion of continuing education required for renewal: 14 hours.
Complete set of electronic fingerprints as required pursuant to Rule 61-
31.101(2)(d), F.A.C.
Please mail your completed application, documentation and required fee(s) to:
Department of Business and Professional Regulation
2601 Blair Stone Road
Tallahassee, FL 32399-0783
DBPR MRS 0701- Application for Licensure
September 2015
Incorporated by Rule: 61-31.101
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Instructions
If you have any questions or need assistance in completing this application, please contact the
Department of Business and Professional Regulation, Customer Contact Center, at 850.487.1395.
1. Application Instructions (by Section)
a. Section I- Application Type
i.
Active Status: This should be checked to request that the license be issued in an
“active” status.
ii.
Inactive Status: This should be checked to request that the license be issued in an
“inactive” status.
iii.
Licensure by Examination Mold Assessor or Mold Remediator: The appropriate
licensure category box should be checked.
iv.
Licensure by Endorsement Mold Assessor or Mold Remediator: The appropriate
licensure category box should be checked.
v.
Check which method of licensure by endorsement the applicant is using to obtain
licensure – based on valid out of state license or by passing a state or national
association exam approved by this state.
vi.
Reinstatement of a Null and Void License: This box should be checked only by an
applicant who has previously held a license and their license is expired. You should only
apply for the same type of license you previously held.
b. Section II- Applicant Information
i.
Fill out each section completely.
ii.
In the Full Legal Name section provide your full legal name as it appears on your license.
Do not use any nicknames or initials. Please list any aliases or prior names in the prior
name information section.
iii.
Provide your mailing address. This will be used for sending correspondence regarding
your application and license.
iv.
Contact information is often used to quickly resolve questions with applications by
telephone call or email. If contact information is not provided, questions regarding
applications will be mailed to the applicant’s mailing address and may take longer to
resolve.
v.
List any licenses that you currently hold or have previously held for a business or
professional license/registration in Florida or elsewhere.
c. Section III- Background Questions
i.
Question 1:
(1)
If you answer “yes” to this question, you must complete Section III (b) [make
additional copies as necessary] of the application and provide a copy of the arrest
report, copies of the disposition or final order(s), and documentation proving all
sanctions have been served and satisfied. You must supply this documentation
for each occurrence. If you are unable to supply this documentation, a certified
statement from the clerk of court for the relevant jurisdiction stating the status of
records is required.
(2)
If you are still on probation, you must supply a letter from your probation officer, on
official letterhead, stating the status of your probation.
ii.
Question 2:
(1)
If you answer “yes” to this question, you must complete Section III (c) [make
additional copies as necessary] of the application and provide a copy of the judgment
or decree. You must also supply documentation proving all sanctions have been
served and satisfied, or if not, stating the current status of any proceedings.
iii.
Question 3:
(1)
If you answer “yes” to this question, you must complete Section III (c) [make
additional copies as necessary] of the application and supply copies of
documentation explaining the denial or pending action.
iv.
Question 4:
(1)
If you answer “yes” to this question, you must complete Section III (c) [make
additional copies as necessary] of the application and supply copies of the order(s)
DBPR MRS 0701- Application for Licensure
September 2015
Incorporated by Rule: 61-31.101
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showing the disciplinary action taken against the license, or documentation showing
the status of the pending action.
d. Section IV- Licensure by Examination
i.
Check the appropriate license type and education and experience combination that you
have completed. Applicants for Mold Remediator must provide either a 2 year associate
of arts degree and 1 year of experience in a field related to mold remediation or a high
school diploma and a minimum of 4 years of experience in a field related to mold
remediation. Applicants for Mold Assessor must provide either a 2 year associate of arts
degree and 1 year of experience in conducting microbial sampling or investigations or a
high school diploma with a minimum of 4 years of experience in conducting microbial
sampling or investigations
ii.
If qualifying with a 2-year degree, list a minimum of 30 semester hours in microbiology,
engineering, architecture, industrial hygiene, occupational safety, biology, chemistry,
environmental, earth or physical science from an accredited institution. Submit a
complete copy of transcripts.
iii.
Provide the required amount of experience to coincide with your education. To establish
each year of experience an applicant must submit a list of at least 15 mold assessments
or remediation projects performed by the applicant. Attach additional sheets as
necessary.
e. Section V – Licensure by Endorsement
i.
Check method of qualification.
ii.
Provide the name of the state in which you are currently licensed/certified.
iii.
Provide the name of the organization that offered the examination.
iii.
Provide the name of the examination completed to obtain license/certification.
iv.
Submit certificate of licensure from the statue you hold a license.
f.
Section VI – Proof of Insurance
i.
Check the appropriate type and amount of the required minimum insurance that you hold.
g.
Section VII – Explanation of Illness or Economic Hardship that Prevented Renewal
i.
Provide an explanation of the illness or economic hardship that prevented renewal of
your license.
ii.
Attach copies as necessary.
h.
Section VIII - Affirmation by Written Declaration
i.
Please read and sign the affirmation by written declaration.
ii.
If the applicant fails to sign the affirmation statement, the Department will not process the
application.
DBPR MRS 0701- Application for Licensure
September 2015
Incorporated by Rule: 61-31.101
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State of Florida
Department of Business and Professional Regulation
Mold Related Services
Application for Licensure
Form # DBPR MRS 0701
If you have any questions or need assistance in completing this application, please contact the
Department of Business and Professional Regulation, Customer Contact Center, at 850.487.1395.
For additional information see the Instructions at the beginning of this application.
Section I- Application Type
CHECK APPLICATION TYPE
Mold Assessor – Active
Mold Assessor – Inactive
Licensure by Examination:
Status [0701/1030]
Status [0701/1034]
Mold Remediator – Active
Mold Remediator – Inactive
Status [0702/1030]
Status [0702/1034]
Mold Assessor - Active
Mold Assessor – Inactive
Licensure by Endorsement:
Status [0701/1035]
Status [0701/1036]
Mold Remediator – Active
Mold Remediator – Inactive
Status [0702/1035]
Status [0702/1036]
Based on out of state license as described in Section 468.8414(3)(b), F.S. (complete S
ections I-III
and V-VII)
OR
Based on passing a state or national association exam approved by this state as described in
Section 468.8414(3)(a), F.S.
(complete Sections I – VII)
Reinstatement of Null and Void
Mold Assessor [0701/1038]
Mold Remediator [0702/1038]
License:
Previous License No.:
 Active Status
 Inactive Status
Section II – Applicant Information
APPLICANT INFORMATION
Social Security Number*
FULL LEGAL NAME
Last/Surname
First
Middle
Suffix
Birth Date (MM/DD/YYYY)
Gender
/
/
 Male  Female
MAILING ADDRESS
Street Address or P.O. Box
City
State
Zip Code (+4 optional)
County (if Florida address)
Country
CONTACT INFORMATION
Primary Phone Number
Primary E-Mail Address
ADDITIONAL CONTACT INFORMATION (OPTIONAL)
Alternate Phone Number
Fax Number
Alternate E-Mail Address
* The disclosure of your Social Security number is mandatory on all professional and occupational license applications, is solicited
by the authority granted by 42 U.S.C. §§ 653 and 654, and will be used by the Department of Business and Professional Regulation
pursuant to §§ 409.2577, 409.2598, 455.203(9), and 559.79(3), Florida Statutes, for the efficient screening of applicants and
licensees by a Title IV-D child support agency to assure compliance with child support obligations. It is also required by § 559.79(1),
Florida Statutes, for determining eligibility for licensure and mandated by the authority granted by 42 U.S.C. § 405(c)(2)(C)(i), to be
used by the Department of Business and Professional Regulation to identify licensees for tax administration purposes.
DBPR MRS 0701- Application for Licensure
September 2015
Incorporated by Rule: 61-31.101
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Section II – Applicant Information – continued
CURRENT/PRIOR LICENSE INFORMATION
If you currently hold or have previously held a business or professional license/registration in Florida or
elsewhere, please list each one below (attach additional copies of this page as necessary):
Date (From)
Date (To)
1. License/Registration Type
State
/
/
/
/
License Number
Name Used
Date (From)
Date (To)
2. License/Registration Type
State
/
/
/
/
License Number
Name Used
Date (From)
Date (To)
3. License/Registration Type
State
/
/
/
/
License Number
Name Used
PRIOR NAME INFORMATION
Have you used, been known as, or are currently known by another name (e.g., maiden name or
nickname) or alias other than the name signed to the application? 
Yes
No
If your answer is yes, state name or names used below:
Last/Surname
First
Middle
Suffix
Last/Surname
First
Middle
Suffix
Last/Surname
First
Middle
Suffix
DBPR MRS 0701- Application for Licensure
September 2015
Incorporated by Rule: 61-31.101
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