Form DBPR ALU1 "Application for Licensure as an Individual" - Florida

What Is Form DBPR ALU1?

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 June 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 ALU1 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 ALU1 "Application for Licensure as an Individual" - Florida

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State of Florida
Department of Business and Professional Regulation
Asbestos Licensing Unit
Application for Licensure as an Individual
Form # DBPR ALU 1
APPLICATION CHECKLIST – IMPORTANT – Submit all items on the checklist below with your
application to ensure faster processing.
APPLICATION REQUIREMENTS
ALL License Applicants must submit:
Pay the fee of $555 for Consultant or Contractor. May checks payable to the Department of Business and
Professional Regulation.
Proof of satisfaction of liens, judgments, and discharge of bankruptcy, if applicable.
Supporting legal documentation, if necessary. See Section 2(m) of Instructions.
ACTIVE License Applicants must also submit:
Credit report on applicant from a nationally recognized credit reporting agency. For a list of agencies, visit
http://www.myfloridalicense.com/dbpr/pro/cilb/documents/cilb_credit_reporting_agencies.pdf.
• See Section 2(m) of Instructions.
Proof of satisfaction of liens, judgments, and discharge of bankruptcy, if applicable.
Submit a Statement of Bonding Limits or an Irrevocable Letter of Credit, or a Compliance Bond made
payable to the Department of Business and Professional Regulation in the amount of $10,000.
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
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. General Requirements for Licensure
a. Definition of “Asbestos Contractor”
i. The person who is qualified and responsible for the contracted project and who offers to,
undertakes to, submits a bid to, or does, individually or by employing others, remove,
encapsulate, or enclose asbestos-containing materials or dispose of asbestos-containing
waste in the course of activities including, but not limited to, construction, renovation,
maintenance, or demolition.
ii.
Applicants for licensure as an asbestos contractor must successfully complete the
following Department-approved courses: an asbestos contractor/supervisor course. Such
course shall consist of not less than 5 days of instruction and a respiratory protection
course. Such course shall consist of not less than 3 days of instruction and provide
evidence of satisfactory work on 10 asbestos projects within the last 5 years and provide
evidence of financial stability. Applicants must also pass a Department-approved
examination of qualifications and knowledge relating to asbestos.
iii. An asbestos contractor may not perform abatement activities involving work that affects
building structures or systems. Work on building structures or systems may be performed
only by a contractor licensed under Chapter 489.
b.
Definition of “Asbestos Consultant”
i.
The person who offers to, undertakes to, submits a bid to, or does, individually or by
employing others, conduct surveys for asbestos-containing materials, develop operation
and maintenance plans, monitor and evaluate asbestos abatement, prepare asbestos
abatement specifications, or perform related tasks.
ii.
All asbestos consultants must be licensed by the department. An asbestos consultant’s
license may be issued only to an applicant who holds a current, valid, active license as
an architect issued under chapter 481; holds a current, valid, active license as a
professional engineer issued under Chapter 471; holds a current, valid, active license as
a professional geologist issued under Chapter 492; is a diplomat of the American Board
DBPR ALU 1 Licensure as an Individual
June 2015
Incorporated by Rule: 61-35.010
1 of 17
State of Florida
Department of Business and Professional Regulation
Asbestos Licensing Unit
Application for Licensure as an Individual
Form # DBPR ALU 1
APPLICATION CHECKLIST – IMPORTANT – Submit all items on the checklist below with your
application to ensure faster processing.
APPLICATION REQUIREMENTS
ALL License Applicants must submit:
Pay the fee of $555 for Consultant or Contractor. May checks payable to the Department of Business and
Professional Regulation.
Proof of satisfaction of liens, judgments, and discharge of bankruptcy, if applicable.
Supporting legal documentation, if necessary. See Section 2(m) of Instructions.
ACTIVE License Applicants must also submit:
Credit report on applicant from a nationally recognized credit reporting agency. For a list of agencies, visit
http://www.myfloridalicense.com/dbpr/pro/cilb/documents/cilb_credit_reporting_agencies.pdf.
• See Section 2(m) of Instructions.
Proof of satisfaction of liens, judgments, and discharge of bankruptcy, if applicable.
Submit a Statement of Bonding Limits or an Irrevocable Letter of Credit, or a Compliance Bond made
payable to the Department of Business and Professional Regulation in the amount of $10,000.
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
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. General Requirements for Licensure
a. Definition of “Asbestos Contractor”
i. The person who is qualified and responsible for the contracted project and who offers to,
undertakes to, submits a bid to, or does, individually or by employing others, remove,
encapsulate, or enclose asbestos-containing materials or dispose of asbestos-containing
waste in the course of activities including, but not limited to, construction, renovation,
maintenance, or demolition.
ii.
Applicants for licensure as an asbestos contractor must successfully complete the
following Department-approved courses: an asbestos contractor/supervisor course. Such
course shall consist of not less than 5 days of instruction and a respiratory protection
course. Such course shall consist of not less than 3 days of instruction and provide
evidence of satisfactory work on 10 asbestos projects within the last 5 years and provide
evidence of financial stability. Applicants must also pass a Department-approved
examination of qualifications and knowledge relating to asbestos.
iii. An asbestos contractor may not perform abatement activities involving work that affects
building structures or systems. Work on building structures or systems may be performed
only by a contractor licensed under Chapter 489.
b.
Definition of “Asbestos Consultant”
i.
The person who offers to, undertakes to, submits a bid to, or does, individually or by
employing others, conduct surveys for asbestos-containing materials, develop operation
and maintenance plans, monitor and evaluate asbestos abatement, prepare asbestos
abatement specifications, or perform related tasks.
ii.
All asbestos consultants must be licensed by the department. An asbestos consultant’s
license may be issued only to an applicant who holds a current, valid, active license as
an architect issued under chapter 481; holds a current, valid, active license as a
professional engineer issued under Chapter 471; holds a current, valid, active license as
a professional geologist issued under Chapter 492; is a diplomat of the American Board
DBPR ALU 1 Licensure as an Individual
June 2015
Incorporated by Rule: 61-35.010
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of Industrial Hygiene; or has been awarded designation as a Certified Safety Professional
by the Board of Certified Safety Professionals.
iii.
Applicants for licensure as an asbestos consultant must successfully complete the
following Department-approved courses: A building asbestos surveys and mechanical
systems course. Such course shall consist of not less than 3 days of instruction, an
asbestos management planning course. Such course shall consist of not less than 2 days
of instruction and a respiratory protection course. Such course shall consist of not less
than 3 days of instruction and a project designer course. Such course shall consist of not
less than 3 days of instruction.
2. Application Instructions (by section)
b. Section I- Application Type
i.
Individual Asbestos Contractor License – Active or Inactive.
(1)
Select this application type if you plan to conduct business as an individual using
your legal name, AND
(2)
You meet the requirements in 1(a) above.
ii.
Individual Asbestos Consultant License – Active or Inactive.
(1)
Select this application type if you plan to conduct business as an individual using
your legal name, AND
(2)
You meet the requirements outlined in 1(b) above.
c. Section II- Applicant Personal Information
i.
Fill out each section completely. A Social Security number is required in order to apply
for any individual license within the Department of Business and Professional Regulation.
ii.
In the Full Legal Name section provide your full legal name as it appears on your Social
Security card. 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.
Applicants are required to provide at least one physical address – i.e., not a P.O. Box. If
the mailing address is not also your physical address, please provide a physical address.
vi.
Additional contact information is optional and will be used when the applicant cannot be
reached using their primary contact information.
vii.
Applicants must provide information on current or prior licenses held in Florida or any
other state, territory, or jurisdiction of the United States or in any foreign national
jurisdiction.
viii.
Applicants must provide the license number and state of any business or professional
licenses currently or previously held.
ix.
Applicants must provide information on any prior names or aliases used by applicant. If
the name on supporting documentation does not match the applicant’s legal name, the
alias used in the supporting documentation must be provided in this section. Failure to do
so will result in a deficient application.
d. Section III- Background Questions
i.
Applicants must submit answers to each of the background questions.
ii.
For each “Yes” answer the person must provide an explanation in Section IV or V, as
applicable.
e. Section IV- Explanations for Background Questions 1 and 2
i.
For these sections, provide as much detail as possible.
ii.
Question 1:
(1)
If you answer “yes” to this question, you must complete Section IV [make additional
copies as necessary] of the application please provide the full details of the criminal
charges including dates, outcomes, sentences, and/or conditions imposed; the dates,
name and location of the court and/or jurisdiction in which any proceedings were held
or are pending. If you answer NO to this question because you believe that previous
incidents have been dismissed, no action taken, nolle prossed, or expunged, you
may be asked to supply documentation as proof of the disposition.
iii.
Question 2:
DBPR ALU 1 Licensure as an Individual
June 2015
Incorporated by Rule: 61-35.010
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(1)
If you answer “yes” to this question, you must complete Section IV [make additional
copies as necessary] of the application and you must also supply documentation
proving the bankruptcy has been discharged or the judgment or lien has been
satisfied, or if not, stating the current status of the bankruptcy, judgment or lien.
iv.
Submit supporting legal documentation, if necessary, with this application.
f.
Section V- Explanations for Background Questions 3 and 4
i.
For these sections, provide as much detail as possible.
ii.
Question 3:
(1)
If you answer “yes” to this question, you must complete Section V [make additional
copies as necessary] of the application and supply copies of documentation
explaining the denial or pending action.
(2)
Provide the full details explaining the denial or pending administrative action
including the nature of any charges, dates, outcomes, sentences, and/or conditions
imposed; the dates, name and location of the court and/or jurisdiction in which any
proceedings were held or are pending; and the designation and/or license number for
any actions against a license or licensure application.
iii.
Question 4:
(1)
If you answer “yes” to this question, you must complete Section V [make additional
copies as necessary] of the application and supply copies of the order(s) (if
applicable) showing the disciplinary action taken against the license or
documentation showing the status of the pending action.
(2)
Provide the full details of any administrative action including the nature of any
charges, dates, outcomes, sentences, and/or conditions imposed; the dates, name
and location of the court and/or jurisdiction in which any proceedings were held or are
pending; and the designation and/or license number for any actions against a license
or licensure application.
iv.
Submit supporting legal documentation, if necessary, with this application.
g. Section VI- Training Courses
i.
Applicants must list the name and address of the training provider, course title, number of CE
Units or class hours, and dates attended. A list of department approved providers and courses
may be found at
http://www.myfloridalicense.com/dbpr/servop/testing/CErequirementsbyboard.html
ii.
Applicants must submit a training verification form for each provider listed.
h. Section VII – Experience Project List
i.
Applicants must provide evidence of satisfactory work on 10 asbestos projects within the
last 5 years in chronological order.
(1)
Provide the project name and address.
(2)
Indicate by checking the appropriate box if the project was satisfactorily completed
with no claim existing.
(3)
Provide the start date, completion date and total time spent on the project.
(4)
Provide a description of the project and level of responsibility you had while working
on the project.
(5)
Indicate if the project included any of the following work: asbestos surveys,
development of operations and maintenance plans, abatement project management
and supervision or design of asbestos abatement projects.
i.
Section VIII- Insurance Coverage- Active Status Applicants Only
i.
Complete this section entirely.
ii.
Applicants must have adequate workers’ compensation and liability insurance.
(1)
Amounts for general liability insurance are specified in the application. Amounts for
workers’ compensation insurance are outlined in
Chapter 440, Florida
Statutes.
(2)
See
Section 469.006, Florida
Statutes, and
Rule 61E1-4.003, F.A.C.
for more
information.
iii.
To verify the accuracy of the signed affidavit, the Board will, from time to time, conduct
random sample audits of licensees by zip code area in which the total number of
certificates and registrations selected for audit will be in a sufficient amount to insure the
validity of the audit.
j.
Section IX- Affirmation by Written Declaration
Applicant must sign the affirmation by written declaration.
i.
k. Section X – Training Verification Form
i.
Applicants must complete the top section entirely.
DBPR ALU 1 Licensure as an Individual
June 2015
Incorporated by Rule: 61-35.010
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(1)
Applicants must indicate the type of license they are seeking.
(2)
Provide your legal name, Social Security number, address and phone number.
(3)
Provide the course title and date of completion.
(4)
Applicant must sign and date the training verification form.
ii.
Registrar/Director of program must complete the bottom section.
(1)
Applicants name must be provided in the blank.
(2)
Registrar/Director must provide course title, dates attended and class room hours
or days in attendance. This list must match your list of training courses listed under
section VI.
(3)
Provide signature, date, training program name, address and phone number.
l.
Section XI – Responsibility Form – Project Verification (duplicate as necessary)
i. Responsibility Form must be verified by the owner or entity for whom the service was
rendered. The professional activities of the applicant can be either verified by the
licensed supervisor for which the applicant completed the job for or the person for whom
the service was rendered to. If the form is completed by the person for whom the service
was rendered, have them complete their information in the Supervisor Information
section.
ii.
Part I: This section should be completed by the applicant.
(1)
Applicants must provide their name, Social Security number, address, phone
number and email address.
(2)
Provide a project name, address and start date/end date.
iii.
Part 2: This section should be completed by the licensed supervisor.
(1)
Provide supervisor’s name, license number, address, name of business and license
number.
(2)
Supervisor must sign and date the certification statement and return to the
Department. These projects must match your project list in section VII.
m.
Financial Responsibility, Credit and Business Reputation Requirements
i.
In order that the Department may carry out its statutory duty to investigate the financial
responsibility, credit and business reputation of a new applicant for licensure, an
applicant shall be required to forward a personal credit report with public records
statement and a statement of bond ability or irrevocable letter of credit for $10,000 or
more to the Department.
ii. Financial responsibility – this requirement is met if the submitted credit report shows no
outstanding unsatisfied judgments or liens against the applicant.’
iii. Applicants must submit proof of satisfaction of liens, judgments, and discharge of
bankruptcy if these are shown on the credit report.
DBPR ALU 1 Licensure as an Individual
June 2015
Incorporated by Rule: 61-35.010
5 of 17
State of Florida
Department of Business and Professional Regulation
Asbestos Licensing Unit
Application for Licensure as an Individual
Form # DBPR ALU 1
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 end of this application.
Section I – Application Type
CHECK ONE OF THE APPLICATION TYPES
 Active [5902/1030]
Inactive [5902/1031]
Asbestos Contractor (Individual)
 Active [5901/1030]
Inactive [5901/1031]
Asbestos Consultant (Individual)
Who holds a current, valid, active license as: (submit a copy of current license/certification)
 Professional Engineer
 Professional Geologist
 Certified Industrial Hygienist
 Professional Architect
 Certified Safety Professional
Section II – Applicant Personal Information
PERSONAL INFORMATION
Social Security Number*
FULL LEGAL NAME
Last Name
First
Middle
Title
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
PHYSICAL ADDRESS (IF DIFFERENT THAN MAILING ADDRESS)
Street Address
City
State
Zip Code (+4 optional)
County (if Florida address)
Country
* 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 ALU 1 Licensure as an Individual
June 2015
Incorporated by Rule: 61-35.010