Revised April 2012
Fee of $280.00 Must Accompany Application ($250.00 license fee & $30.00 Application Fee
Application Fee is NOT Refundable
Type or print your name in ink as it appears on your driver’s license .
1. NAME: _______________________________________________________________________________________________
First Middle Last
2. STREET ADDRESS:_____________________________________________________________________________________
City State Zip
3. TELEPHONE: ( ____ ) ___________________ ( ____ ) ___________________ ( ____ ) __________________________
Residence Business Cell
4. SSN: _______/_____/______ DRIVER’S LICENSE NUMBER: __________________ BIRTH DATE:_____/______/_____
5. HEIGHT: _____________ WEIGHT: ____________ HAIR: _______________ EYES: ______________
6. E-Mail address:_________________________________________________________
7. Are you a US Citizen? Yes ____ No ____ If no, please provide Immigration Document.
8. APPLICANT’S SIGNATURE: _______________________________________________ DATE: ______/______/________
The applicant signing this Application being duly sworn declares that the statements subscribed to by him/her are true to
the best of his/her knowledge and that he/she personally signed this Application.
9. Complete information below for course(s) taken. Attach a copy of your certificate verifying at least 90 hours of approved
home inspection training. If you are applying based upon 90 hours of equivalent training, please explain and provide all
documentation of training as approved by the Committee.
Type of School Name and Location Date of Attendance Certificate
Provided
Yes No
8. Have you ever been convicted or pled nolo contendere to a felony? (Title 310: 276-9-1 states: Applicants for
home inspection license examination must be of eighteen (18) years of age or older and be of good moral character……)
□ Yes □ No If yes, attach a complete explanation
Home Inspector License Application by Examination
Construction Industries Board
2401 NW 23rd Street, Suite 2F
Oklahoma City, OK 73107
Telephone: (405) 521-6550
FAX: (405) 521-6525
http://www.ok.gov/cib/
Revised April 2012
Page 1 of 2
Please mail $280 (license fee & application fee) check or money order made payable to the Construction
Industries Board with this application, and any supporting documentation to:
Construction Industries Board
Home Inspectors Licensing
2401 NW 23rd Street, Suite 2F
Oklahoma City, OK 73107
DO NOT WRITE BELOW THIS LINE -- FOR CIB STAFF USE ONLY
Applicant approved to sit for exam: ______________________________________________________________.
Date
Applicant passed National Home Inspector Exam: _________________________________________.
Date
$50,000 General Liability Insurance Certificate received: ____________________________________.
Date
Revised April 2012
Page 2 of 2
Instructions for Required Affidavit:
All natural persons fourteen (14) years of age or older and present in the United States, applying for a license with
the Oklahoma Construction Industries Board are required, by the provisions of 56 O.S. Supp. 2007 § 71, to provide the
Board with verification of lawful presence in the United States by executing one of the Affidavits below before a notary
public or other officer authorized to notarize affidavits under State law. The Board’s licensing offices are staffed with
notaries who are available to provide notary service at no cost to Applicants.
AFFIDAVIT VERIFYING LAWFUL PRESENCE IN THE UNITED STATES
Option 1 - Verification of Citizenship
Affidavit of
_______________________________ STATE OF OKLAHOMA )
[Applicant’s Full Name] ) ss: __________
COUNTY OF _______________ )
____________________________, of lawful age, being first duly sworn, upon oath states, under penalty of perjury, as
[Applicant’s Full Name] follows:
I am a United States Citizen.
____________________________________
[Signature of Applicant]
Subscribed and sworn to or affirmed before me this ____ day of ______________, 20____, by ____________________.
[Applicant]
My Commission Expires: _________________ __________________________________
NOTARY (Seal)
Option 2 - Affidavit Verifying Qualified Alien Status
Attention: This affidavit will not be accepted without a copy of a valid immigration document which reflects the
applicants
"A" number or "I-94" number.
Affidavit of
_______________________________ STATE OF OKLAHOMA )
[Applicant’s Full Name] ) ss: __________
COUNTY OF _______________ )
____________________________, of lawful age, being first duly sworn, upon oath states, under penalty of perjury, as
[Applicant’s Full Name] follows:
I am a qualified alien under the federal Immigration and Naturalization Act, and I am lawfully present in the United
States.
____________________________________
[Signature of Applicant]
Subscribed and sworn to or affirmed before me this ____ day of ______________, 20____ , by ___________________.
[Applicant]
My Commission Expires: _______________ (Seal) ____________________________________
NOTARY
