CONTRACTORS STATE LICENSE BOARD
9821 Business Park Drive, Sacramento, CA 95827
STATE OF CALIFORNIA
Mailing Address: P.O. Box 26000, Sacramento, CA 95826
Arnold Schwarzenegger, Governor
13A-11 (rev. 01/06)
Certification of Work Experience – Page 1 of 2
CERTIFICATION OF WORK EXPERIENCE
This form must be filled in completely in order to document work experience or the application will be returned. You must type
or print neatly and legibly in black or dark blue ink – pencil is not acceptable.
Original signatures are required – faxed, photocopied, or stamped signatures are not acceptable.
All qualifying individuals and certifiers must be at least 18 years old.
All Certification of Work Experience forms must be submitted with the application.
The Certification of Work Experience form, when filed with an application, becomes the property of CSLB and is kept as a matter of
record. Make a copy of the completed and signed form for your records – you may be asked to provide further documentation or
testimony to verify your experience.
If, within the last five (5) years, you have either qualified for or passed an examination in the classification for which you are now
applying, you do not need to complete this form. Such applicants should complete the Application for Original Contractor’s License –
Examination Waiver (7065). However, if you are applying for a waiver of the examination pursuant to B&P Code Sections 7065.1(b) or
7065.1(c), you do need to complete this form. (Please refer to Blueprint for Becoming a Licensed Contractor for more information on exam
Anyone who knowingly obtains or offers false or forged documents to be filed, registered, or recorded in any public office in
California is guilty of a felony. (Penal Code Section 115)
PART 1 – QUALIFYING INDIVIDUAL NAME AND WORK EXPERIENCE
The qualifying individual must document at least four (4) full years of experience in the cl