Plumbing - Endorsement of Employer

State of Maryland Department of Labor, Licensing And Regulation Maryland State Board Of Plumbing 500 N. Calvert St., Room 302 Baltimore, Maryland 21202-3651 ------410-230-6164 (Baltimore area) or 1-888-218-5925 (toll free) Plumbing - Endorsement of Employer 1. General Instructions: a. Do supply a form for each employer, indicating hours worked, if you have been employed by more than one Master Plumber, Master Plumber/Gas fitter or Master Natural Gas Fitter, during the time in question. b. Do complete sections 2 (Applicant’s Personal Information) and 3 (Regarding Work Experience Qualifications.) c. Do ask your Master to complete sections 4 (Documented Work Experience), 5 (Master’s Information) and 6 (Master’s Certification.) d. Do submit this form, when you file for your examination. e. Do make and retain copies of the signed, completed form(s) for your records.

2. Applicant’s Personal Information: License Registration Number: ______

Name: First: ______Middle: ______Last: ______

Street Address: ______

City: ______State: ______Zip: ______

Social Security Number: ______- ____ - _____ Daytime Phone Number: _____ - _____ - _____

3. Regarding Work Experience Qualifications: Please checkmark the item that describes your current license status and work situation:

 Apprentice Plumber/Gas Fitter, working toward a Journey Plumber/Gas Fitter license: for this, you will need at least 4 years as a licensed apprentice and 7500 hours of training, under a Master Plumber/Gas Fitter.

 Apprentice Plumber/Gas Fitter, working toward a Journey Natural Gas Fitter license: for this, you will need at least 3 years as a licensed apprentice and 3750 hours of gasfitting training, under a Master Plumber/Gas Fitter or Master Natural Gas Fitter.   Journey Plumber/Gas Fitter, working toward a Master Plumber/Gas Fitter license: for this, you will need at least 2 years as a licensed journey and 3750 hours of training, under a Master Plumber/Gas Fitter.

 Apprentice Natural Gas Fitter, working toward a Journey Natural Gas Fitter license: for this, you will need at least 2 years as a licensed apprentice and 3750 hours of gasfitting training, under a Master Plumber/Gas Fitter or Master Natural Gas Fitter.

If your current license status and work situation is not listed above, please contact the Board. 4. Documented Work Experience: All reported hours must be worked under the supervision, direction and control of the licensed Master Plumber, Master Plumber/Gas Fitter or Master Natural Gas Page 1 State of Maryland Department of Labor, Licensing And Regulation Maryland State Board Of Plumbing 500 N. Calvert St., Room 302 Baltimore, Maryland 21202-3651 ------410-230-6164 (Baltimore area) or 1-888-218-5925 (toll free) Fitter, certifying this work. Served From Served To Hours Hours (Plumbing (Natural Gas & Fitting only) Propane Gas only) Month Day Year Month Day Year

Total Hours: 5. Master’s Information:

Company Name: ______

Street Address: ______

City: ______State: ______Zip: ______

License Type: Master Plumber, Master Plumber/Gas Fitter, Master Natural Gas Fitter

License Registration Number: ______State or Jurisdiction of License: ______6. Master’s Certification:

I certify under penalty of perjury that I am a currently-licensed Master Plumber, Master Plumber/Gas Fitter or Master Natural Gas Fitter and that the following applicant:

Social Security Number: ______- ____ - ______has served as a Journey or Apprentice Plumber/Gas Fitter or Natural Gas Fitter, under my supervision, direction and control for the time(s) indicated in the table above.

Signed Name of Master: ______

Date Signed: ______