CONSTRUCTION INDUSTRIES DIVISION WATER WELL PUMP INSTALLER ELECTRICAL SPECIALTY LICENSE HISTORY: The following memo was sent from the CID Electrical Bureau Chief to a staff person at the State Engineer s office on October 29, 1996. The letter details that Water Well Drillers are not authorized by the State Engineer to perform electrical work on water well systems (except to install the pump and cable). It further details that in order to perform electrical work associated with water well systems (supply power, connect pump, controls etc.,) a person has to be properly licensed and certified by CID. If not, then all electrical work related to a water well system has to be done by a properly licensed electrical contractor. Or the pump installer can take the necessary steps to get properly licensed by CID (by completing a 4 year apprenticeship under a Journeyman Electrician and passing the Journeyman Electrical test).
This 1998 memo outlines CID s instructions to all electrical inspectors, clearly stating that all portions of the electrical installation are to be done by properly licensed individuals.
While pump installers and inspectors widely ignored both memos, the majority of pump installers were aware they were performing the electrical work without a proper license. Even before these memo s, the association knew that not having a pump installer license was not a good thing. There were many efforts over the years to get a license that encompassed ALL FACETS of pump work under the State Engineer s office. These attempts were not successful largely due to the fact that the State Engineer s Office refused to accept the responsibility for a pump license. From 1996 through 2008 the association made numerous attempts to get legislation passed that would force a true pump installer license under the State Engineer. Each attempt was passionately fought, not only by the State Engineer, but also by the agricultural community, rural Legislators and later joined by the Realtors Association and the Farm Bureau.
Fast forward to July 22, 2008. A licensed well driller and member of the NMGWA received the following ENFORCEMENT LETTER. At this point it became glaringly obvious that CID was no longer going to ignore unlicensed pump installers wiring water systems. This letter outlines that an unlicensed person may not legally advertise, bid, perform or contract for construction work in New Mexico and that unlicensed contracting is a criminal offense. The person would have 3 options: 1. Obtain the appropriate license and pay a fine up to 10% on all work contracted and up to a 3% fine on all work bid in the last 12 months. 2. Choose not to become licensed and pay a fine of 10% on all contracted work in the last year, pay a 5% fine on all work bid in the last 12 months as well as a 10% fee on the total amount fined. Agree to never work as a contractor in the state of New Mexico. 3. In the event option 1 or 2 are not chosen, felony charges will be filed.
Keep in mind this all came about when the construction industry had slowed down, there were a lot of inspectors with very little work and this was a real threat to pump installers. Don t forget that the only option available for legally wiring the water systems was to obtain a full blown Journeyman Electrical License. After several attempts of proposing a Pump Installer License, in early 2009 CID agreed to back off the enforcement efforts until a resolution could be reached. The NMGWA proposed a very in depth Pump Installer license based on the NGWA Certified Pump Installer exams and the Colorado Pump Installer License. The proposal encompassed sizing and installing pumps, submersible wire, drop pipe, horizontal water lines, pressure tanks, storage tanks, pressure switches, controls, floats and well pits. Almost immediately the Mechanical Bureau denied implementing any of the pump and plumbing work associated with the proposal for 2 reasons; 1) they didn t know anything about pumps and pressure tanks and 2) they didn t want to know anything about them. They did however, agree to allow all plumbing work related to the water system to be done without becoming a licensed plumber as long as a person is a licensed well driller (outlined in the OSE/CID MOU - available in the Members Only section) - or if they obtain the eventual pump license. This left the electrical side. At first they were only willing to allow up to a 5 HP Single Phase motor and even drafted a license to reflect this. However, the Association fought very hard for the next several years to get the Electrical Bureau to revise their stance and draft a license that would allow pump installers to continue working on the higher horse power and higher voltages that many in the state work on. In the end they proposed 2 categories; Residential (up to 15 HP Single Phase, 240 Volt) and Commercial (unlimited HP, Single & Three Phase up to 600 Volts). Both licenses encompass the work that is incidental to the water system installation (excavation, trenching, plumbing). Is it perfect? Absolutely not! Is it better than what we started with? Absolutely! This is strictly an ELECTRICAL LICENSE and does not address anything related to water system installations as a typical pump installer license in other states would encompass. While it is not ideal for our industry, it did provide an avenue for pump installers to LEGALLY continue the electrical work that goes hand in hand with water system installations. And the avenue is far easier to navigate than obtaining a full blown Journeyman Electrical License. This is a voluntary license, if a pump installer chooses NOT to get the license there are ramifications that should be considered as outlined in the enforcement letter above: FOR THOSE WITHOUT A WELL DRILLERS LICENSE: An unlicensed person may not legally advertise, bid, perform or contract for construction work. An unlicensed person may not legally sub-contract to another contractor. In short an unlicensed pump installer would have not the authority to perform the work. FOR THOSE THAT ARE LICENSED WELL DRILLERS THE OSE/CID MOU RECOGNIZES YOU AS A LICENSED CONTRACTOR, AS SUCH: You would be allowed to contract for, and install all of the components related to the water system installation, connect the wire to and set the pump. You WOULD NOT BE ALLOWED TO connect the wires at the surface or wire any of the controls. You would be allowed to sub-contract directly with a licensed electrician or licensed pump installer for the electrical work.
LICENSE OVERVIEW: ES-10 R. Residential water well pump installer. Requires two years experience. This classification covers residential water well pumps,120/240 volts or less, single phase 15 HP or less. Install, maintain, repair or replace electrical equipment, wiring, and accessories used in connection with water well pump systems, including single phase variable frequency drives. Also includes subpanels, luminaires, and receptacle outlets installed within the well pit or well enclosure. Branch circuit or feeder conductors from the service equipment or panelboard to the well pump location. Incidental excavation, trenching and solar photovoltiac arrays 5 kw or less when dedicated to pumping equipment. This classification does not include systems over 240 volts, pumps over 15 HP, electrical services, building wiring or any other electrical wiring. ES-10. Water well pump installer. Requires two years experience. This classification covers residential and commercial water well pumps, 600 volts or less, single or three phase. Install, maintain, repair or replace electrical equipment wiring and accessories used in connection with water well pump systems, including variable frequency drives. Also includes subpanels, luminaires, and receptacle outlets installed within the well pit or well enclosure, Branch circuit or feeder conductors from the service equipment or panelboard to the well pump location. Incidental excavation, trenching and solar photo-voltaic arrays 5 kw or less when dedicated to pumping equipment. This classification does not include systems over 600 volts, electrical services, building wiring or any other electrical wiring. APPLICATION PROCESS: Because this is a specialty license and the applicants do not currently hold a CID issued license, the CID Electrical Bureau Chief and the Licensing Manager will be hand reviewing each application. First, you will fill out the application and they will review and approve your eligibility to take the exams. If your application is denied, they will notify you as to why. Once your application is approved, you have 6 months to take the test. Qualifying Party/Contractor License: The business owner or person appointed by the owner must apply for the QP/Contractor license. At this time that person may also request to receive the Journeyman classification without taking both exams. NOTE: If the business appoints a QP and that person leaves, the business has 6 months to either take the exams or find another QP. Journeyman License: Any technicians working in the field without direct supervision by a Journeyman will be required to take the Journeyman exam. NOTE: For a residential license, a Journeyman may have 3 apprentices working under him and for commercial, a Journeyman may have 2 apprentices.
PSI ES10/ES10J & ES10R/ES10RJ WORK EXPERIENCE VERIFICATION NEW MEXICO CONTRACTOR LICENSING SERVICE THIS WORK EXPERIENCE VERIFICATION MUST BE SUBMITTED WITH AN APPLICATION AND APPROVED BEFORE EXAMS MAY BE SCHEDULED. TYPE OR PRINT CLEARLY. PLEASE READ THE FOLLOWING INSTRUCTIONS PRIOR TO COMPLETING THE ATTACHED WORK EXPERIENCE VERIFICATION. FOLLOWING INSTRUCTIONS COMPLETELY WILL AVOID DELAYS IN PROCESSING APPLICATION. INSTRUCTIONS FOR THE APPLICANT Only the top portion of the Affidavit is to be completed by the Applicant. Complete ALL information requested. One or more Forms may be completed and submitted to meet the experience requirements. ALL EXPERIENCE MUST BE WITHIN THE LAST 10 YEARS. Approval shall be given to test ONLY for the license classifications(s) listed on the Affidavit. NOTE: You may include education/technical training to satisfy the experience requirement. For qualifying party candidates, each year of training may be credited as one-half (1/2) year of experience, but in no case shall credited training exceed one-half (1/2) of the total experience requirement. Please include copies of your official transcripts and/or certificates. INSTRUCTIONS FOR EXPERIENCE VERIFICATION Individuals who are qualified to complete the Affidavit are as follows: Employers (past or present), Supervisors, Foremen, and other Contractors. Answer all the questions completely and fully. DO NOT LEAVE ANY BLANKS. Supervisors and foremen must submit proof/verification of their position within the company. Out of state Contractors must attach a copy of their current state license to the affidavit. If your experience is with a company is a state that does not require a license, you must submit proof/verification that the company is an active/valid company. (tax certificate, business license listing the company name, corporation papers, etc.) PROVIDE THIS INFORMATION WITH THE APPLICATION PROVING THE TIME IN BUSINESS YOU CAN PROVIDE THIS FOR YOUR EMPLOYEES ALSO ALONG WITH THEIR START DATE Describe the Applicant s hands-on work experience in DETAIL. Estimating, project manager, ordering supplies, and supervising is not considered hands-on. You must specify if the applicant has residential and/or commercial work experience. Be as detailed as possible as to the hands-on experience the Applicant has in his/her field. Statements such as, Experienced in construction of residential homes, alone, WILL NOT BE ACCEPTED. The work experience verification must be signed by the person certifying the experience and notarized. All attachments must be signed by the person certifying the work experience. THIS IS NOT POSSIBLE SINCE THIS IS A NEW LICNESE All experience must have been gained while employed by a contractor licensed in the trade being applied for, or considered legal work in the state in which the work was performed. There are some limited exceptions to this work experience requirement. For example certain military, volunteer, and homeowner experience may be used in some circumstances. Please contact PSI for more information regarding these exceptions. Work experience requirements are a minimum of: TWO YEARS (4,000 HOURS) ES10 ES10J ES10R ES10RJ For a description of the scope of work allowed under each classification, please refer to the Regulation and Licensing Department, New Mexico Administrative Code, Classifications and Scopes (can be found online at public.psiexams.com) APPLICANT: Upon completion of the Affidavit, please deliver original(s) by mail or in person to: PSI, 2301 YALE BLVD SE, SUITE C4, ALBUQUERQUE, NM, 87106 (PLEASE INCLUDE A SELF-ADDRESSED, STAMPED ENVELOPE) Please allow 10-14 working days for processing. If approved, PSI will mail you an eligibility card containing exam registration and scheduling information. Updated 04/15/2013 public.psiexams.com 1 of 2
Construction Industries Division ES10/ES10J & ES10R/ES10RJ EXPERIENCE AFFIDAVIT A COMPLETED QUALIFYING PARTY APPLICATION MUST BE SUBMITTED WITH THIS AFFIDAVIT. USE ONLY INK AND DO NOT MAKE CORRECTIONS USING CORRECTIVE FLUID OR ANY OTHER MEANS. INCOMPLETE, ILLEGIBLE OR CORRECTED FORMS WILL BE REJECTED, RETURNED AND PROCESSING WILL BE DELAYED. DO NOT LEAVE ANY BLANKS! Candidate Name: Date: Address: City: State: Zip: SS#: CLASSIFICATION(S) APPLYING FOR (GB98, GA98, GF98 ETC.) Describe in DETAIL the applicant s HANDS-ON work demonstrated to your satisfaction; the necessary knowledge and skill to be fully qualified perform the work, without supervision. Please refer to instructions for further explanation. (Please attach a separate sheet if necessary *All attachments must be referred to and signed. (CIRCLE ONE) 1. THIS WORK WAS PERFORMED FROM / TO / PART TIME or FULL TIME MO YR MO YR Hours per Week WHILE APPLICANT WAS EMPLOYED BY CO. LICENSE # Attach a copy of the license *If your experience is with a company from a state that does not require a license, you must submit proof/verification that the company is an active/valid company. (Tax certificate, business license listing the company name, corporation papers, etc.) 2. ADDITIONAL WORK EXPERIENCE INFORMATION ATTACHED YES NO (attachment must be signed) 3. APPLICANT S POSITION WHILE PERFORMING WORK: (CHECK ONE) JOURNEYMAN FOREMAN SUPERVISOR CONTRACTOR OTHER 4. I HELD THE FOLLOWING POSITION WHILE APPLICANT WAS PERFORMING THE WORK. (CHECK ONE) EMPLOYER CONTRACTOR SUPERVISOR FOREMAN OTHER *Contractors must attach a copy of their current state license. If your position with the company does not require a license, you must submit proof/verification of your position with the company. In making this certification for (candidate name), I (person certifying), have not relied on statements made to me by applicant or third parties, and swear under penalty of perjury that the information provided in this certification is true and correct to the best of my personal knowledge. I understand that my license may be subject to discipline if the information given and attested to by me herein is determined to be intentionally misleading or fraudulent. Signature of Person Certifying LICENSE # STATE Attach a copy of the license Address City State Zip Phone # Fax # Email NOTARY: Subscribed and sworn before me this day of 20 SEAL Notary Public My commission expires, 20 Updated 04/15/2013 public.psiexams.com 2 of 2
HOW TO OBTAIN A QUALIFYING PARTY CERTIFICATE ONE: IMPORTANT NOTE: TWO: notarized notarizedeach TWO YEARS (4,000 hours) FOUR YEARS (8,000 HOURS) (GB-2) (GS-1 through GS-34 GA-1 through GA-5) (GF-1 through GF-9) (ER-1) (ES-1 through ES-7) (MS-3 and MS-6) ES-10/ES-10J AND ES-10R/ES-10RJ 2 YEARS (GB-98) (GA98) (GF-98) (EE-98) (EL-1) (MM-98) (MM-1) (MM-2) (MM-3) (MM-4) (MS-12) (MS-14) SINCE THIS IS A NEW LICNESE THIS IS NOT APPLICABLE 1
HELPFUL TIP: Have your experience verification form completed and notarized in duplicate. Keep an original signed and notarized form in your files. This will be useful if you need to reapply. THREE non-refundable each NOT All notarized forms submitted must be original INCOMPLETE PACKETS WILL NOT BE PROCESSED FOUR: FIVE: SIX: Failure to attach to a valid license withinthose 12 months will result in the automatic cancellation of your QP certificate. NOTE: 2
NEW MEXICO APPLICATION for QUALIFYING PARTY CERTIFICATE 1. APPLICANT INFORMATION 2. CLASSIFICATIONS. DO NOT USE THIS FORM TO APPLY FOR JOURNEYMAN CERTIFICATION. ES10 OR THE ES10 R TO REQUEST JOURNEYMAN AT THE SAME TIME, FILL OUT HE JOURNEYMAN APPLCIATION 3. QUALIFYING PARTY HISTORY QP Name EXTENSION you If YES, attach a detailed explanation
*** ***THE ANSWER TO THIS QUESTION SHOULD BE "NO" AS THIS IS A NEW LICENSE 4. AFFIRMATION AND SIGNATURE I hereby affirm, under penalty of perjury, 5. NOTARY
6. PAYMENT. EACH PSI, 2301 Yale Blvd. S.E., Ste C-4, Albuquerque, NM 87106 ALL SUBMISSIONS MUST INCLUDE ORIGINAL DOCUMENTS. YOU MAY NOT SUBMIT AN APPLICATION BY FAX. : : For your security, PSI requires you to enter the card identification number located on your credit card. The card identification number is located on the back of the card and consists of the last three digits on the signature strip.
ANY PERSON WORKING IN THE FIELD WITHOUT DIRECT SUPERVISION BY A JOURNEYMAN WILL HAVE TO OBTAIN THIS LICENSE. HOW TO OBTAIN A NEW MEXICO JOURNEYMAN CERTIFICATE In New Mexico, electrical, mechanical and plumbing work must be performed by, or under the supervision of, someone who has a journeyman certificate for the classification of work being performed. Therefore, even if you have a contractor s license in one or more of those classifications, you must also be, or employ, a certified journeyman to perform the work. BECAUSE THIS IS A NEW LICENSE, THE ABOVE IS NOT GOING TO APPLY ONE: Determine the certificate classification required to do the work you plan to perform. Journeymen classifications can be found in New Mexico Administrative Code, Title 14, Chapter 6, Part 6 at www.nmcpr.state.nm.us. ES-10J OR ES -10R J IMPORTANT NOTE: If uncertain of the proper classification, submit a Classification Determination form to PSI along with a detailed description of the work to be performed. If a journeyman certificate is required in connection with work that will be awarded based on a competitive bidding process, be sure to include a copy of the project scope of work. To ensure clear communication, responses to Classification Determination Form requests are not made by phone. Forms are available online at public.psiexams.com. A written Classification Determination will be mailed or faxed to you. TWO: Submit complete application packet. The application package must include: 1. Complete, legible, signed and notarized Journeyman Certificate Application. 2. Complete, legible, signed and notarized work experience verification form for EACH classification you wish to test for. Use one form per employer/affiant verifying your work experience, and use the work experience verification form specific to those classifications. There is a work experience form for Mechanical/Plumbing trades, and there is a work experience form for Electrical trades. Note: Individuals who are qualified to complete the Affidavit are as follows: Employers (past or present), Supervisors, Foremen, and other Contractors. DO NOT LEAVE ANY BLANKS. The experience requirements are: Four Years (8,000 hours): Electrical EE-98J Journeyman residential and commercial electrical EL-1J Journeyman electrical distribution systems, including transmission lines. Two Years (4,000): Electrical ER-1J Journeyman residential wiring. ES-1J Journeyman electrical signs and outline lighting. ES-2J Journeyman cathodic protection and lightening protection systems. ES-3J Journeyman sound, intercommunication, electrical alarm systems, and systems 50 volts and under. ES-7J Journeyman telephone communication systems and telephone interconnect systems. ES-10J OR THE ES-10RJ WATER WELL PUMP INSTALLER Plumbing/Mechanical JP Journeyman plumber JPF Journeyman pipe fitter JG Journeyman gas fitter JPG Journeyman plumber and natural gas fitter JR Journeyman refrigeration JS Journeyman sprinkler JSM Journeyman sheet metal PUBLIC.PSIEXAMS.COM Revised 11/01/2012 1
Six Months (1,000 hours): BO1 Journeyman boiler operator - low pressure only BO2 Journeyman boiler operator low and high pressure NOTE: The JW - Journeyman welder and JMG-Journeyman medical gas installer classifications are certified by endorsement to certain existing journeyman certificates only - no separate experience is required although there are additional requirements. See Administrative Code for more information (section 14.9.5.8-14.9.5.10 & 14.6.6.11 C-8). All experience must have been gained while employed by a contractor licensed in the trade being applied for, or considered legal work in the state in which the work was performed. There are some limited exceptions to the work experience requirement. Military, volunteer and home owner experience may be used in some circumstances. Please contact PSI for more information on these exceptions. NOTE: Reciprocity applicants do not need to submit work experience forms; however must be currently active for at least one year in the state in which they tested. See question #3 C on Journeyman Application. HELPFUL TIP: Have your experience verification form completed and notarized in duplicate. Keep an original signed and notarized form in your files. This will be useful if you need to reapply. Correct Journeyman Certificate Application fee: $75.00 (per classification) A self-addressed stamped envelope (letter-size) with sufficient return postage. This envelope will be used to send your application packet back to you if your submission is rejected. THREE: Complete packets must be delivered by hand or mail. Faxed or emailed forms will NOT be accepted. All notarized forms submitted must be original. Submit completed packets to: PSI 2301 Yale SE, Ste. C-4 Albuquerque, NM 87106 877-663-9267 INCOMPLETE PACKETS WILL NOT BE PROCESSED. If your packet is incomplete, incorrect or insufficient, it will be returned to you. FOUR: After your application has been accepted and your experience has been verified and approved, you will be notified by USPS that you have been approved to test. Applicants who have been approved to test will also be posted on the PSI web site daily at www.psiexams.com FIVE: SIX: Once you have been approved to test, you must schedule for, take, and pass the required exam(s). You may schedule to test by calling PSI at 1-800-733-9267, or online at www.psiexams.com. (Each exam requires a separate fee.) Submit passing exam score reports. 1. Be sure to safeguard all of your original exam score reports. Once you receive passing score reports for all required exam(s), you must submit the original score report(s) to PSI in order to complete the processing and issuing of your journeyman certificate(s). You should retain a copy of your exam score reports for your records. 2. If you do not submit your passing score reports within six months from the date PSI approves your application, your application fee will be forfeited and your application will be purged and you will have to file for an extension by submitting a new Journeyman Certificate Application (new affidavit not required). 3. If you report passing scores within six months, you will receive your certificate(s) by USPS. Scores are valid for one (1) year; any score letter over a year old will not be accepted. SEVEN: Your New Mexico Journeyman s Certificate will be active for three years effective the last day of the month of issuance. Please see How to Renew you Journeyman Certificate for renewal information. PUBLIC.PSIEXAMS.COM Revised 11/01/2012 2
NEW MEXICO APPLICATION for JOURNEYMAN CERTIFICATE AN INCOMPLETE, INCORRECT OR OTHERWISE DEFECTIVE APPLICATION WILL NOT BE PROCESSED AND APPLICATION FEES WILL NOT BE REFUNDED. PRINT CLEARLY. USE ALL CAPITALS. 1. APPLICANT INFORMATION Today s Date (MM/DD/YYYY) / / First Name Middle Name Last Name Address City State Zip Code Social Security Number Age Daytime Phone Alternative Phone 2. CLASSIFICATIONS. Enter the classification(s) for which you are applying. Consult the New Mexico Administrative Code 14.6.6.10 & 14.6.6.11 for Classifications. For example: EE98J, JP, JG. **DO NOT USE THIS FORM TO APPLY FOR CONTRACTOR CERTIFICATION. Classification Classification Name ES-10J OR ES-10RJ (OFFICAL USE ONLY) Cert # (OFFICAL USE ONLY) Cert # (OFFICAL USE ONLY) Cert # 3. HISTORY a. Are you applying for an approval EXTENSION for an application that was NO YES previously submitted? b. Are you applying for a journeyman classification that parallels a classification NO YES you hold as an active qualifying party for a valid license? If yes, indicate lic # (work verification form not required) c. EE98J only - If you are applying under the reciprocity program*, attach a copy of current certificate that you hold from the state in which you tested. Have you been certified in this state for at least one year? NO YES *Members of the multi-state reciprocal electrical license group are: Alaska, Arkansas, Colorado, Idaho, Montana, Nebraska, Oklahoma, South Dakota, Texas, Utah, and Wyoming (work verification form not required). d. Do you have any unresolved complaints pending with CID? NO YES e. Are there any unpaid judgements against you? NO YES f. Do you have any outstanding fines with CID? NO YES g. Have you bid or performed any unlicensed work in the last 12 months? NO YES If yes please provide a written explanation of the circumstances. h. Are you current with child support regulations in New Mexico? NO YES OFFICIAL USE ONLY DATE / / AMOUNT $ MC VS AMEX CASH CK CK# APPROVAL IS VALID UNTIL: / / BY: public.psiexams.com Revised 11/01/2012 Page 1 of 2
i. Are you a graduate of an electrical trade school? If yes : NO YES Name of School: Address of School: Please attach official transcripts. j. Are you a graduate of an apprenticeship program? If yes : NO YES Name of Program: Address of Program: k. Have you previously taken the New Mexico Electrical Journeyman (EE98-J) NO YES If yes : Date of exam: l. Are you applying for a journeyman refrigeration certificate? NO YES If yes, you must attach proof of your EPA certification for refrigerant recovery. 4. AFFIRMATION AND SIGNATURE I understand that unless I am a validly licensed contractor in the field for which this certificate applies, I am limited to working as an employee of an annual permit holder or New Mexico contractor, licensed in the trade for which I am certified, and that I am prohibited from engaging in the work covered under this certification through any type of contract. I further understand that any false statement by me in this application may result in administrative action against any certification issued on the basis of this application. I further acknowledge that I am required to immediately notify PSI, in writing, of any change of address. Applicant Signature Please print your full name Date, 20 5. NOTARY Subscribed and sworn before me this day of 20 SEAL Notary Public My commission expires, 20 6. PAYMENT. Submit Application Packet and $75.00 Payment for EACH classification, payable to PSI (by walk-in or mail): Submit Application Packet and Payment to (by walk-in or mail): PSI, 2301 Yale Blvd. S.E., Ste C-4, Albuquerque, NM 87106 (877) 663-9267 public.psiexams.com Walk-in payments may be made by cash, personal check, company check money order, cashiers check, VISA or MasterCard. Mail payments may be made by personal check, company check money order, cashiers check, VISA or MasterCard (NO CASH). ALL SUBMISSIONS MUST INCLUDE ORIGINAL DOCUMENTS. YOU MAY NOT SUBMIT AN APPLICATION BY FAX. (Check one): MC VISA Full Card No: Expiration Date: Card Verification No: For your security, PSI requires you to enter the card identification number located on your credit card. The card identification number is located on the back of the card and consists of the last three digits on the signature strip. Cardholder Name (print): Signature: public.psiexams.com Revised 11/01/2012 Page 2 of 2
The Full Candidate Bulletin can be downloaded at: http://www.public.psiexams.com/index_login.jsp (under Contractor Licensing) Data, Voice, and Video Cabling, Jim Hayes and Paul CONTRACTOR/Qualifying Rosenberg, 2005, Delmar/Thomson Party will take Learning, the (800) 347- ES-10 OR7707, ES-10R. www.delmarlerning.com, At the time ofisbn application 1401827616 the Contractor can choose to receive a Journeyman Card Candidates would are not responsible be required for bringing to take their own references to the Journeyman the examination test. center. Reference materials must be bound, and may be highlighted, underlined, and/or indexed prior to the examination session. Reference materials containing any JOURNEYMAN writing will WOULD not be BE allowed EMPLOYEES into the OF examination. THE CONTRACTOR References WORKING may IN not THE be written FIELD. in during They would the examination then take session. the Any ES-10J candidate or the caught ES-10RJ. writing in the references during the examination will have the references confiscated and will be On the application, keep your experience specific to reported to the department. Furthermore, candidates are not installation permitted to of bring pumps,switches, in any additional control papers (loose boxes,panels. or attached) Ask your with their suppliers approved orreferences. customersany for additional verification materials of will experience be removed letters. from the references and confiscated. References may be tabbed/indexed with permanent tabs only. Temporary tabs, such as Post-It notes, are not allowed and must be removed from the reference before the examination begins. ES-10 Water Well Pump Installer # of Questions % Required to Pass Time Allowed 50 75% (38 points) 120 Minutes CONTENT OUTLINE Subject Area # of Items General Knowledge and Electrical Installation Requirements 8 Feeders and Branch Circuits 4 Overcurrent Protection 3 Grounding and Bonding 8 Conductors and Cables 5 Raceways and Boxes 5 Panelboards and Switchboards 5 Motors, Pumps, and Controls 6 Solar PV Systems 3 New Mexico Electrical Code 3 REFERENCE LIST The reference materials listed below were used to prepare the questions for this examination. The examination may also contain questions based on trade knowledge or general industry practices. Except for Code books, you can base your answers on later editions of references as they become available. For Code questions, the examinations will be based only on the edition of the Code book that is listed. Candidates may use a silent, non-printing, non-programmable calculator in the examination center. This examination is OPEN BOOK. The following reference materials are allowed in the examination center: NFPA 70 National Electrical Code, 2011, or The National Electrical Code Handbook, National Fire Protection Association (NFPA), (800) 344-3555, www.nfpa.org New Mexico Electrical Code (NMAC 14.10.4), 2011, www.nmcpr.state.nm.us/nmac, (505) 476-4700 National Electrical Safety Code, 2007, Institute of Electrical and Electronics Engineers, Inc., (732) 981-0060, www.ieee.org, ISBN 0-7381-2778-7 The following reference materials are not allowed in the examination center: American Electricians Handbook, 15th Edition, McGraw- Hill, (800) 262-4729, www.books.mcgraw-hill.com, ISBN: 0-07-137735 Ugly's Electrical References, George V. Hart, 2008 or 2011, Jones and Bartlett, (800) 832-0034, www.uglys.net, ISBN 978-0-7637-7126-3. All items are based on either the 2008 or 2011 editions. Candidates are responsible for bringing their own references to the examination center. Reference materials must be bound, and may be highlighted, underlined, and/or indexed prior to the examination session. Reference materials containing any writing will not be allowed into the examination. References may not be written in during the examination session. Any candidate caught writing in the references during the examination will have the references confiscated and will be reported to the department. Furthermore, candidates are not permitted to bring in any additional papers (loose or attached) with their approved references. Any additional materials will be removed from the references and confiscated. References may be tabbed/indexed with permanent tabs only. Temporary tabs, such as Post-It notes, are not allowed and must be removed from the reference before the examination begins. ES-10R Residential Water Well Pump Installer # of Questions % Required to Pass Time Allowed 50 75% (38 points) 120 Minutes CONTENT OUTLINE Subject Area # of Items General Knowledge and Electrical Installation Requirements 9 Feeders and Branch Circuits 5 Overcurrent Protection 3 Grounding and Bonding 9 Conductors and Cables 5 Raceways and Boxes 5 Panelboards and Switchboards 3 Motors, Pumps, and Controls 5 Solar PV Systems 3 New Mexico Electrical Code 3 REFERENCE LIST The reference materials listed below were used to prepare the questions for this examination. The examination may also contain questions based on trade knowledge or general industry practices. Except for Code books, you can base your answers on later editions of references as they become available. For Code questions, the examinations will be based only on the edition of the Code book that is listed. WWW.PSIEXAMS.COM 14
PSI Online - One stop Solution for Test Takers TEST CENTER LOCATIONS 9/5/13 8:59 AM Test Centers Test Center Selection Please select a country: USA Please select a State: New Mexico This test is conducted at the following test centers: City/State Address Driving Directions Albuquerque, New Mexico Farmington, New Mexico Las Cruces, New Mexico Roswell, New Mexico Santa Fe, New Mexico 2301 Yale Blvd SE, Building C, Suite 4 1307 E. 20th Street, 1001 N. Solano, Suite D 105 E. Fifth Street, 4001 Office Court Drive, Suite 301 From Interstate 25, take the Gibson Blvd exit and travel East on Gibson Blvd until you reach Yale Blvd Southeast. Turn right on Yale Blvd S.E. (heading South), just past Renard Place and then turn right into the Commerce Center. The site is across the street from the Waffle House and Comfort Inn. From E. Main St, turn RIGHT on Sullivan and turn LEFT on 20th St. 1307 E 20th St in parking lot of Eagle Real Estate, look for big blue and white sign for Eagle Real Estate. Between Maggie Sews and Eagle Real Estates. No Sign, sign is on the door. If you pass Daves Sports Shop or Fatboys, you have gone too far. From the North, take I-25 South and take Exit #6/US-70/US-82 toward Alamogordo/Las Cruces. Turn RIGHT on North Main St./US-70. Continue on North Main St. for a little over a mile and turn LEFT on North Solano Dr. Continue on North Solano for a mile and turn RIGHT on Pinon St. where you will see 1001 North Solano Drive. From the South, take I-25 North and exit toward Las Cruces/Albuquerque. Take the 3 Exit toward East Lohman Ave. (NM-342). Turn LEFT on East Lohman Ave. and continue on NM-342 West. Turn RIGHT on Solano Dr. and go approximately one mile and turn LEFT on Pinon St. where you will see 1001 North Solano Dr. From US-285 S / US-70 W, turn LEFT onto E 5TH ST. From Albuquerque International Sunport Airport: Head East on Sunport Blvd SE. Merge onto I-25 N via the ramp to I-40/Downtown and Santa Fe. Take exit 278 and merge onto Cerrillos Road/NM-14 N. Approximately 2.5 miles north on Cerrillos Road, turn right on Wagon Road. Turn right on Office Court Drive into the office park. From Espanola, NM and North Cities: Head Southeast on East Paseo De Onate/US-285S/US-84S (toward Calle Espinosa). Continue on Sandia Drive. Slight right at South Riverside Drive/US-285S/US-84S. Turn right on Cerrillos Road. Approximately 5 miles on Cerrillos Road, turn left on Wagon Road. Turn right on Office Court Drive into the office park. Close Copyright 2000-2013 PSI. ALL RIGHTS RESERVED. Version 1.70.0.1 Privacy Policy PSI Corporate Test's can also be taken in Amarillo PSI Testing-Amarillo LASPS951 4312 Teckla-Ste 500 Amarillo, TX 79109 https://candidate.psiexams.com/registration/testcenter_details.jsp?testid=805&statename=new%20mexico&country=usa Page 1 of 1
BUSINESS AND LAW APPROVED COURSES CONSTRUCTION SEMINARS, INC 4411 McLeod NE, Ste B Albuquerque, NM 87109 800-942-3212 or 505-883-3885 CNM WORKFORCE TRAINING CENTER 5600 Eagle Rock Rd NE Albuquerque, NM 87113 505-883-3885 CNM 525 Buena Vista SE Albuquerque, NM 87106 505-224-3783 (Course Title & # L CM175) ALBUQUERQUE CAREERSTITUTE 111 Wyoming NE Albuquerque, NM 87123 800-247-1300 or 505 260-0000
PSI ES10/ES10J & ES10R/ES10RJ WORK EXPERIENCE VERIFICATION NEW MEXICO CONTRACTOR LICENSING SERVICE THIS WORK EXPERIENCE VERIFICATION MUST BE SUBMITTED WITH AN APPLICATION AND APPROVED BEFORE EXAMS MAY BE SCHEDULED. TYPE OR PRINT CLEARLY. PLEASE READ THE FOLLOWING INSTRUCTIONS PRIOR TO COMPLETING THE ATTACHED WORK EXPERIENCE VERIFICATION. FOLLOWING INSTRUCTIONS COMPLETELY WILL AVOID DELAYS IN PROCESSING APPLICATION. INSTRUCTIONS FOR THE APPLICANT Only the top portion of the Affidavit is to be completed by the Applicant. Complete ALL information requested. One or more Forms may be completed and submitted to meet the experience requirements. ALL EXPERIENCE MUST BE WITHIN THE LAST 10 YEARS. Approval shall be given to test ONLY for the license classifications(s) listed on the Affidavit. NOTE: You may include education/technical training to satisfy the experience requirement. For qualifying party candidates, each year of training may be credited as one-half (1/2) year of experience, but in no case shall credited training exceed one-half (1/2) of the total experience requirement. Please include copies of your official transcripts and/or certificates. INSTRUCTIONS FOR EXPERIENCE VERIFICATION Individuals who are qualified to complete the Affidavit are as follows: Employers (past or present), Supervisors, Foremen, and other Contractors. Answer all the questions completely and fully. DO NOT LEAVE ANY BLANKS. Supervisors and foremen must submit proof/verification of their position within the company. Out of state Contractors must attach a copy of their current state license to the affidavit. If your experience is with a company is a state that does not require a license, you must submit proof/verification that the company is an active/valid company. (tax certificate, business license listing the company name, corporation papers, etc.) Describe the Applicant s hands-on work experience in DETAIL. Estimating, project manager, ordering supplies, and supervising is not considered hands-on. You must specify if the applicant has residential and/or commercial work experience. Be as detailed as possible as to the hands-on experience the Applicant has in his/her field. Statements such as, Experienced in construction of residential homes, alone, WILL NOT BE ACCEPTED. The work experience verification must be signed by the person certifying the experience and notarized. All attachments must be signed by the person certifying the work experience. All experience must have been gained while employed by a contractor licensed in the trade being applied for, or considered legal work in the state in which the work was performed. There are some limited exceptions to this work experience requirement. For example certain military, volunteer, and homeowner experience may be used in some circumstances. Please contact PSI for more information regarding these exceptions. Work experience requirements are a minimum of: TWO YEARS (4,000 HOURS) ES10 ES10J ES10R ES10RJ For a description of the scope of work allowed under each classification, please refer to the Regulation and Licensing Department, New Mexico Administrative Code, Classifications and Scopes (can be found online at public.psiexams.com) APPLICANT: Upon completion of the Affidavit, please deliver original(s) by mail or in person to: PSI, 2301 YALE BLVD SE, SUITE C4, ALBUQUERQUE, NM, 87106 (PLEASE INCLUDE A SELF-ADDRESSED, STAMPED ENVELOPE) Please allow 10-14 working days for processing. If approved, PSI will mail you an eligibility card containing exam registration and scheduling information. Updated 04/15/2013 public.psiexams.com 1 of 2
Construction Industries Division ES10/ES10J & ES10R/ES10RJ EXPERIENCE AFFIDAVIT A COMPLETED QUALIFYING PARTY APPLICATION MUST BE SUBMITTED WITH THIS AFFIDAVIT. USE ONLY INK AND DO NOT MAKE CORRECTIONS USING CORRECTIVE FLUID OR ANY OTHER MEANS. INCOMPLETE, ILLEGIBLE OR CORRECTED FORMS WILL BE REJECTED, RETURNED AND PROCESSING WILL BE DELAYED. DO NOT LEAVE ANY BLANKS! Candidate Name: Date: Address: City: State: Zip: SS#: CLASSIFICATION(S) APPLYING FOR (GB98, GA98, GF98 ETC.) Describe in DETAIL the applicant s HANDS-ON work demonstrated to your satisfaction; the necessary knowledge and skill to be fully qualified perform the work, without supervision. Please refer to instructions for further explanation. (Please attach a separate sheet if necessary *All attachments must be referred to and signed. (CIRCLE ONE) 1. THIS WORK WAS PERFORMED FROM / TO / PART TIME or FULL TIME MO YR MO YR Hours per Week WHILE APPLICANT WAS EMPLOYED BY CO. LICENSE # Attach a copy of the license *If your experience is with a company from a state that does not require a license, you must submit proof/verification that the company is an active/valid company. (Tax certificate, business license listing the company name, corporation papers, etc.) 2. ADDITIONAL WORK EXPERIENCE INFORMATION ATTACHED YES NO (attachment must be signed) 3. APPLICANT S POSITION WHILE PERFORMING WORK: (CHECK ONE) JOURNEYMAN FOREMAN SUPERVISOR CONTRACTOR OTHER 4. I HELD THE FOLLOWING POSITION WHILE APPLICANT WAS PERFORMING THE WORK. (CHECK ONE) EMPLOYER CONTRACTOR SUPERVISOR FOREMAN OTHER *Contractors must attach a copy of their current state license. If your position with the company does not require a license, you must submit proof/verification of your position with the company. In making this certification for (candidate name), I (person certifying), have not relied on statements made to me by applicant or third parties, and swear under penalty of perjury that the information provided in this certification is true and correct to the best of my personal knowledge. I understand that my license may be subject to discipline if the information given and attested to by me herein is determined to be intentionally misleading or fraudulent. Signature of Person Certifying LICENSE # STATE Attach a copy of the license Address City State Zip Phone # Fax # Email NOTARY: Subscribed and sworn before me this day of 20 SEAL Notary Public My commission expires, 20 Updated 04/15/2013 public.psiexams.com 2 of 2
HOW TO OBTAIN A QUALIFYING PARTY CERTIFICATE ONE: IMPORTANT NOTE: TWO: notarized notarizedeach TWO YEARS (4,000 hours) FOUR YEARS (8,000 HOURS) (GB-2) (GS-1 through GS-34 GA-1 through GA-5) (GF-1 through GF-9) (ER-1) (ES-1 through ES-7) (MS-3 and MS-6) (GB-98) (GA98) (GF-98) (EE-98) (EL-1) (MM-98) (MM-1) (MM-2) (MM-3) (MM-4) (MS-12) (MS-14) 1
HELPFUL TIP: Have your experience verification form completed and notarized in duplicate. Keep an original signed and notarized form in your files. This will be useful if you need to reapply. THREE non-refundable each NOT All notarized forms submitted must be original INCOMPLETE PACKETS WILL NOT BE PROCESSED FOUR: FIVE: SIX: Failure to attach to a valid license withinthose 12 months will result in the automatic cancellation of your QP certificate. NOTE: 2
NEW MEXICO APPLICATION for QUALIFYING PARTY CERTIFICATE 1. APPLICANT INFORMATION 2. CLASSIFICATIONS. DO NOT USE THIS FORM TO APPLY FOR JOURNEYMAN CERTIFICATION. 3. QUALIFYING PARTY HISTORY QP Name EXTENSION you If YES, attach a detailed explanation
4. AFFIRMATION AND SIGNATURE I hereby affirm, under penalty of perjury, 5. NOTARY
6. PAYMENT. EACH PSI, 2301 Yale Blvd. S.E., Ste C-4, Albuquerque, NM 87106 ALL SUBMISSIONS MUST INCLUDE ORIGINAL DOCUMENTS. YOU MAY NOT SUBMIT AN APPLICATION BY FAX. : : For your security, PSI requires you to enter the card identification number located on your credit card. The card identification number is located on the back of the card and consists of the last three digits on the signature strip.
HOW TO OBTAIN A NEW MEXICO JOURNEYMAN CERTIFICATE In New Mexico, electrical, mechanical and plumbing work must be performed by, or under the supervision of, someone who has a journeyman certificate for the classification of work being performed. Therefore, even if you have a contractor s license in one or more of those classifications, you must also be, or employ, a certified journeyman to perform the work. ONE: Determine the certificate classification required to do the work you plan to perform. Journeymen classifications can be found in New Mexico Administrative Code, Title 14, Chapter 6, Part 6 at www.nmcpr.state.nm.us. IMPORTANT NOTE: If uncertain of the proper classification, submit a Classification Determination form to PSI along with a detailed description of the work to be performed. If a journeyman certificate is required in connection with work that will be awarded based on a competitive bidding process, be sure to include a copy of the project scope of work. To ensure clear communication, responses to Classification Determination Form requests are not made by phone. Forms are available online at public.psiexams.com. A written Classification Determination will be mailed or faxed to you. TWO: Submit complete application packet. The application package must include: 1. Complete, legible, signed and notarized Journeyman Certificate Application. 2. Complete, legible, signed and notarized work experience verification form for EACH classification you wish to test for. Use one form per employer/affiant verifying your work experience, and use the work experience verification form specific to those classifications. There is a work experience form for Mechanical/Plumbing trades, and there is a work experience form for Electrical trades. Note: Individuals who are qualified to complete the Affidavit are as follows: Employers (past or present), Supervisors, Foremen, and other Contractors. DO NOT LEAVE ANY BLANKS. The experience requirements are: Four Years (8,000 hours): Electrical EE-98J Journeyman residential and commercial electrical EL-1J Journeyman electrical distribution systems, including transmission lines. Two Years (4,000): Electrical ER-1J Journeyman residential wiring. ES-1J Journeyman electrical signs and outline lighting. ES-2J Journeyman cathodic protection and lightening protection systems. ES-3J Journeyman sound, intercommunication, electrical alarm systems, and systems 50 volts and under. ES-7J Journeyman telephone communication systems and telephone interconnect systems. Plumbing/Mechanical JP Journeyman plumber JPF Journeyman pipe fitter JG Journeyman gas fitter JPG Journeyman plumber and natural gas fitter JR Journeyman refrigeration JS Journeyman sprinkler JSM Journeyman sheet metal PUBLIC.PSIEXAMS.COM Revised 11/01/2012 1
Six Months (1,000 hours): BO1 Journeyman boiler operator - low pressure only BO2 Journeyman boiler operator low and high pressure NOTE: The JW - Journeyman welder and JMG-Journeyman medical gas installer classifications are certified by endorsement to certain existing journeyman certificates only - no separate experience is required although there are additional requirements. See Administrative Code for more information (section 14.9.5.8-14.9.5.10 & 14.6.6.11 C-8). All experience must have been gained while employed by a contractor licensed in the trade being applied for, or considered legal work in the state in which the work was performed. There are some limited exceptions to the work experience requirement. Military, volunteer and home owner experience may be used in some circumstances. Please contact PSI for more information on these exceptions. NOTE: Reciprocity applicants do not need to submit work experience forms; however must be currently active for at least one year in the state in which they tested. See question #3 C on Journeyman Application. HELPFUL TIP: Have your experience verification form completed and notarized in duplicate. Keep an original signed and notarized form in your files. This will be useful if you need to reapply. Correct Journeyman Certificate Application fee: $75.00 (per classification) A self-addressed stamped envelope (letter-size) with sufficient return postage. This envelope will be used to send your application packet back to you if your submission is rejected. THREE: Complete packets must be delivered by hand or mail. Faxed or emailed forms will NOT be accepted. All notarized forms submitted must be original. Submit completed packets to: PSI 2301 Yale SE, Ste. C-4 Albuquerque, NM 87106 877-663-9267 INCOMPLETE PACKETS WILL NOT BE PROCESSED. If your packet is incomplete, incorrect or insufficient, it will be returned to you. FOUR: After your application has been accepted and your experience has been verified and approved, you will be notified by USPS that you have been approved to test. Applicants who have been approved to test will also be posted on the PSI web site daily at www.psiexams.com FIVE: SIX: Once you have been approved to test, you must schedule for, take, and pass the required exam(s). You may schedule to test by calling PSI at 1-800-733-9267, or online at www.psiexams.com. (Each exam requires a separate fee.) Submit passing exam score reports. 1. Be sure to safeguard all of your original exam score reports. Once you receive passing score reports for all required exam(s), you must submit the original score report(s) to PSI in order to complete the processing and issuing of your journeyman certificate(s). You should retain a copy of your exam score reports for your records. 2. If you do not submit your passing score reports within six months from the date PSI approves your application, your application fee will be forfeited and your application will be purged and you will have to file for an extension by submitting a new Journeyman Certificate Application (new affidavit not required). 3. If you report passing scores within six months, you will receive your certificate(s) by USPS. Scores are valid for one (1) year; any score letter over a year old will not be accepted. SEVEN: Your New Mexico Journeyman s Certificate will be active for three years effective the last day of the month of issuance. Please see How to Renew you Journeyman Certificate for renewal information. PUBLIC.PSIEXAMS.COM Revised 11/01/2012 2
NEW MEXICO APPLICATION for JOURNEYMAN CERTIFICATE AN INCOMPLETE, INCORRECT OR OTHERWISE DEFECTIVE APPLICATION WILL NOT BE PROCESSED AND APPLICATION FEES WILL NOT BE REFUNDED. PRINT CLEARLY. USE ALL CAPITALS. 1. APPLICANT INFORMATION Today s Date (MM/DD/YYYY) / / First Name Middle Name Last Name Address City State Zip Code Social Security Number Age Daytime Phone Alternative Phone 2. CLASSIFICATIONS. Enter the classification(s) for which you are applying. Consult the New Mexico Administrative Code 14.6.6.10 & 14.6.6.11 for Classifications. For example: EE98J, JP, JG. **DO NOT USE THIS FORM TO APPLY FOR CONTRACTOR CERTIFICATION. Classification Classification Name (OFFICAL USE ONLY) Cert # (OFFICAL USE ONLY) Cert # (OFFICAL USE ONLY) Cert # 3. HISTORY a. Are you applying for an approval EXTENSION for an application that was NO YES previously submitted? b. Are you applying for a journeyman classification that parallels a classification NO YES you hold as an active qualifying party for a valid license? If yes, indicate lic # (work verification form not required) c. EE98J only - If you are applying under the reciprocity program*, attach a copy of current certificate that you hold from the state in which you tested. Have you been certified in this state for at least one year? NO YES *Members of the multi-state reciprocal electrical license group are: Alaska, Arkansas, Colorado, Idaho, Montana, Nebraska, Oklahoma, South Dakota, Texas, Utah, and Wyoming (work verification form not required). d. Do you have any unresolved complaints pending with CID? NO YES e. Are there any unpaid judgements against you? NO YES f. Do you have any outstanding fines with CID? NO YES g. Have you bid or performed any unlicensed work in the last 12 months? NO YES If yes please provide a written explanation of the circumstances. h. Are you current with child support regulations in New Mexico? NO YES OFFICIAL USE ONLY DATE / / AMOUNT $ MC VS AMEX CASH CK CK# APPROVAL IS VALID UNTIL: / / BY: public.psiexams.com Revised 11/01/2012 Page 1 of 2
i. Are you a graduate of an electrical trade school? If yes : NO YES Name of School: Address of School: Please attach official transcripts. j. Are you a graduate of an apprenticeship program? If yes : NO YES Name of Program: Address of Program: k. Have you previously taken the New Mexico Electrical Journeyman (EE98-J) NO YES If yes : Date of exam: l. Are you applying for a journeyman refrigeration certificate? NO YES If yes, you must attach proof of your EPA certification for refrigerant recovery. 4. AFFIRMATION AND SIGNATURE I understand that unless I am a validly licensed contractor in the field for which this certificate applies, I am limited to working as an employee of an annual permit holder or New Mexico contractor, licensed in the trade for which I am certified, and that I am prohibited from engaging in the work covered under this certification through any type of contract. I further understand that any false statement by me in this application may result in administrative action against any certification issued on the basis of this application. I further acknowledge that I am required to immediately notify PSI, in writing, of any change of address. Applicant Signature Please print your full name Date, 20 5. NOTARY Subscribed and sworn before me this day of 20 SEAL Notary Public My commission expires, 20 6. PAYMENT. Submit Application Packet and $75.00 Payment for EACH classification, payable to PSI (by walk-in or mail): Submit Application Packet and Payment to (by walk-in or mail): PSI, 2301 Yale Blvd. S.E., Ste C-4, Albuquerque, NM 87106 (877) 663-9267 public.psiexams.com Walk-in payments may be made by cash, personal check, company check money order, cashiers check, VISA or MasterCard. Mail payments may be made by personal check, company check money order, cashiers check, VISA or MasterCard (NO CASH). ALL SUBMISSIONS MUST INCLUDE ORIGINAL DOCUMENTS. YOU MAY NOT SUBMIT AN APPLICATION BY FAX. (Check one): MC VISA Full Card No: Expiration Date: Card Verification No: For your security, PSI requires you to enter the card identification number located on your credit card. The card identification number is located on the back of the card and consists of the last three digits on the signature strip. Cardholder Name (print): Signature: public.psiexams.com Revised 11/01/2012 Page 2 of 2