In the realm of professional development within the Commonwealth of Kentucky, the Elevator Mechanic License Application holds a pivotal role for individuals seeking licensure in this specialized field. Administered by the Division of Building Codes Enforcement, Elevator Section of the Public Protection Cabinet, Department of Housing, Buildings, and Construction, this form embodies a crucial step towards certification. Applicants are required to provide comprehensive details encompassing personal information, employment history, and a thorough record of their elevator-related experience, including education and training. A recent, passport-sized photograph is also a necessity alongside the application fee made payable to the Kentucky State Treasurer, underscoring the formality and seriousness of the certification process. Beyond personal and professional documentation, the application delves into the applicant’s history with elevator mechanic licensure, if applicable, and mandates acknowledgment of various compliance and truthfulness statements concerning student loan defaults and the accuracy of information provided. The form, known as Form EV-4, evolves into more than just a simple application; it is a testament to an applicant's preparedness, experience, and reliability, serving as both a gateway and barrier to a highly specialized profession. The accompanying instructions further delineate requirements such as proof of experience, examination results if applying under certain conditions, and a detailed initial fee chart tailored according to the applicant's birth month and application period, all designed to streamline the licensing pathway while ensuring rigor and thoroughness.
| Question | Answer |
|---|---|
| Form Name | Kentucky Elevator Mechanic License Form |
| Form Length | 4 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min |
| Other names | kentucky elevator licence renewal form, kentucky form elevator printable, kentucky elevator mechanic license, renew kentucky elevator license |
COMMONWEALTH OF KENTUCKY
Public Protection Cabinet
Department of Housing, Buildings and Construction
DIVISION OF BUILDING CODES ENFORCEMENT
ELEVATOR SECTION
101 Sea Hero Road, Suite 100
Frankfort, Kentucky
Telephone:
ELEVATOR MECHANIC LICENSE APPLICATION
Please type or print application. Answer all questions on both sides of this application.
An application fee is to be submitted payable to Kentucky State Treasurer.
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Name: _________________________________________________________________ |
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passport- sized, color |
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Address: _______________________________________________________________ |
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photograph of applicant |
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Email address: __________________________ |
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2.Current Employer or Company Name: ______________________________________
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Federal ID Number (Business) ____________________________________________ |
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3. Elevator Experience History: Education, Training or Apprenticeship Program
*Use additional sheets, if necessary. Begin with most recent work, education or training experience.
Name of Company/School/Apprenticeship Program: _______________________________________________________
Address: ___________________________________________________________________________________________
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Dates of Attendance: |
From ____/____/____ To ____/____/____ |
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Type of Elevator Work/Training ________________________________________________________________________
____________________________________________________________________________________________________
Form
Name of Company/School/Apprenticeship Program: _______________________________________________________
Address: ___________________________________________________________________________________________
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From ____/____/____ To ____/____/____ |
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Type of Elevator Work/Training ________________________________________________________________________ |
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4. Have you previously held a Elevator Mechanic’s license in the Commonwealth of Kentucky? |
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If yes, list license number and date you were first licensed. (Attach copy of license, if available) |
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License Number: _______________ Date: ________________ |
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The commissioner, in accordance with KRS Chapter 13B, may refuse to issue, suspend, revoke, or refuse to renew the license or certificate of any licensee or certificate holder pursuant to KRS 198B.4033.
Please fill in each circle acknowledging that you have included the following:
O Completed Application and required supplemental documentation (valid for one year from date of receipt)
O An initial application fee (submitted to the Department and payable to Kentucky State Treasurer).
_____ (Initial) I am not in default of any student loans backed by the KHEAA (Kentucky Higher Education Assistance
Authority). I understand that if I am in default of any student loans backed by the KHEAA, I cannot receive a Kentucky Elevator Mechanic license at this time.
______(Initial) I confirm that all information contained on and submitted with this application is current and true to the best
of my knowledge.
Applicant’s Signature: _______________________________________________________ Date:___________________
COMMONWEALTH OF KENTUCKY |
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COUNTY OF_____________________ |
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The applicant, whose name is, |
, being duly sworn declares that foregoing |
subscribed statements are true to the best of their knowledge and belief, and that they have personally signed this application.
Subscribed and sworn to before me thisday of_________________, _______
Notary Public ______________________________
My Commission expires: ______________________
For Office Use Only
Date Received_____________________
Approved ________________________
Issue ____________________________
Pending __________________________
Board Review _____________________
Elevator Mechanic # ________________
Issue & Status _____________________
Read this section carefully!
The following information shall be submitted with application:
One Passport sized photograph taken within 3 months of application.
Documentation for verification of experience. (i.e. official Tax documents, copies of business licenses, sworn affidavit attesting to your experience or any other valid documentation of experience). For a complete list of documentation examples, go online to http://dhbc.ky.gov.
If applicable for proof of experience, Mechanic license applicants shall provide a copy of certificate of completion of nationally recognized training program, apprenticeship program or apprenticeship registration.
Proof of passage of written, oral, or computerized examination if applying pursuant to KRS 198B.4013(2)(a).
Passage of a written, oral, or computerized examination administered by the department based upon the most recent referenced codes and standards
Annual Fee for Elevator Mechanic License $96 ($8 per month)
A nonrefundable fee must be submitted with this application. Without this fee, this application will not be processed.
License shall be
Mail checks only.
Credit card payments are available online.
Make checks payable to Kentucky State Treasurer.
Elevator Mechanic License
Initial Fee Chart
Use the chart below to determine the correct fee for application. The fee is based on your birth month and the month which you are applying. Add the fees if you are applying for multiple licenses.
Example: If you were born in October and you are applying in July, then the Elevator Mechanic application fee is $120. This license would be valid for 15 months. Each time you renew your license after your initial activation, your license will be valid for one year and will be subject to annual renewal in October (your birth month).
Birth Month
Elevator Mechanic License
Month you are Applying
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Jan |
Feb |
Mar |
Apr |
May |
Jun |
Jul |
Aug |
Sep |
Oct |
Nov |
Dec |
Jan |
$96.00 |
$88.00 |
$80.00 |
$72.00 |
$64.00 |
$56.00 |
$144.00 |
$136.00 |
$128.00 |
$120.00 |
$112.00 |
$104.00 |
Feb |
$104.00 |
$96.00 |
$88.00 |
$80.00 |
$72.00 |
$64.00 |
$56.00 |
$144.00 |
$136.00 |
$128.00 |
$120.00 |
$112.00 |
Mar |
$112.00 |
$104.00 |
$96.00 |
$88.00 |
$80.00 |
$72.00 |
$64.00 |
$56.00 |
$144.00 |
$136.00 |
$128.00 |
$120.00 |
Apr |
$120.00 |
$112.00 |
$104.00 |
$96.00 |
$88.00 |
$80.00 |
$72.00 |
$64.00 |
$56.00 |
$144.00 |
$136.00 |
$128.00 |
May |
$128.00 |
$120.00 |
$112.00 |
$104.00 |
$96.00 |
$88.00 |
$80.00 |
$72.00 |
$64.00 |
$56.00 |
$144.00 |
$136.00 |
Jun |
$136.00 |
$128.00 |
$120.00 |
$112.00 |
$104.00 |
$96.00 |
$88.00 |
$80.00 |
$72.00 |
$64.00 |
$56.00 |
$144.00 |
Jul |
$144.00 |
$136.00 |
$128.00 |
$120.00 |
$112.00 |
$104.00 |
$96.00 |
$88.00 |
$80.00 |
$72.00 |
$64.00 |
$56.00 |
Aug |
$56.00 |
$144.00 |
$136.00 |
$128.00 |
$120.00 |
$112.00 |
$104.00 |
$96.00 |
$88.00 |
$80.00 |
$72.00 |
$64.00 |
Sep |
$64.00 |
$56.00 |
$144.00 |
$136.00 |
$128.00 |
$120.00 |
$112.00 |
$104.00 |
$96.00 |
$88.00 |
$80.00 |
$72.00 |
Oct |
$72.00 |
$64.00 |
$56.00 |
$144.00 |
$136.00 |
$128.00 |
$120.00 |
$112.00 |
$104.00 |
$96.00 |
$88.00 |
$80.00 |
Nov |
$80.00 |
$72.00 |
$64.00 |
$56.00 |
$144.00 |
$136.00 |
$128.00 |
$120.00 |
$112.00 |
$104.00 |
$96.00 |
$88.00 |
Dec |
$88.00 |
$80.00 |
$72.00 |
$64.00 |
$56.00 |
$144.00 |
$136.00 |
$128.00 |
$120.00 |
$112.00 |
$104.00 |
$96.00 |