Form DMM-BMME-2 "Verification of Work Experience Form" - Virginia

What Is Form DMM-BMME-2?

This is a legal form that was released by the Virginia Department of Mines, Minerals and Energy - a government authority operating within Virginia. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2017;
  • The latest edition provided by the Virginia Department of Mines, Minerals and Energy;
  • 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 DMM-BMME-2 by clicking the link below or browse more documents and templates provided by the Virginia Department of Mines, Minerals and Energy.

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Division of Mineral Mining
Fontaine Research Park
900 Natural Resources Drive, Suite 400
Charlottesville, VA 22903
434-951-6316
Verification of Work Experience Form
Type or complete this form in ink. Complete a separate form for each employer to certify the
experience requirements have been met & have it signed by a company official knowledgeable of
your work history. Scan and attach to an online certification application or mail the completed &
signed form to the Division of Mineral Mining.
1.
Full Name:
DMM ID:
2.
Address:
Street or PO Box
City
State
Zip Code
3.
Employer/Company Name:
Mine Name:
VA Mine Permit Number:
Employer Phone #:
(
)
Address:
Street or PO Box
City
State
Zip Code
4a.
Job Title:
From :
To:
Month/Day/Year
Month/Day/Year
(Complete all 3 blanks)
(Complete all 3 blanks)
Detailed description of mining-related job duties that are applicable to certification requested:
4b.
Job Title:
From :
To:
Month/Day/Year
Month/Day/Year
(Complete all 3 blanks)
(Complete all 3 blanks)
Detailed description of mining-related job duties that are applicable to certification requested:
I hereby certify that the information related to this applicant’s experience as submitted on
this form is correct.
Signature of Company Official
Print or Type Name
Title
Date
DMM-BMME-2 (Revised 03/17)
Division of Mineral Mining
Fontaine Research Park
900 Natural Resources Drive, Suite 400
Charlottesville, VA 22903
434-951-6316
Verification of Work Experience Form
Type or complete this form in ink. Complete a separate form for each employer to certify the
experience requirements have been met & have it signed by a company official knowledgeable of
your work history. Scan and attach to an online certification application or mail the completed &
signed form to the Division of Mineral Mining.
1.
Full Name:
DMM ID:
2.
Address:
Street or PO Box
City
State
Zip Code
3.
Employer/Company Name:
Mine Name:
VA Mine Permit Number:
Employer Phone #:
(
)
Address:
Street or PO Box
City
State
Zip Code
4a.
Job Title:
From :
To:
Month/Day/Year
Month/Day/Year
(Complete all 3 blanks)
(Complete all 3 blanks)
Detailed description of mining-related job duties that are applicable to certification requested:
4b.
Job Title:
From :
To:
Month/Day/Year
Month/Day/Year
(Complete all 3 blanks)
(Complete all 3 blanks)
Detailed description of mining-related job duties that are applicable to certification requested:
I hereby certify that the information related to this applicant’s experience as submitted on
this form is correct.
Signature of Company Official
Print or Type Name
Title
Date
DMM-BMME-2 (Revised 03/17)