Additional Personnel -CSLB

Easy-Fill Form

The following must be completed by all individuals and companies that will be listed on the license. You must provide full legal names of all individuals. Each individual must sign the certification statement under penalty of perjury. (See Section 4 of the General Information and Instructions regarding company personnel.)

This is an Easy-Fill form that will walk you through the process to fully and accurately complete this form. Upon completion, you will be required to print and submit the document to CSLB.

IMPORTANT NOTES:

Be sure to use the "Back" and "Next" buttons at the bottom of each page - do not use your browser's back arrow because all of your entered information will be erased and you will have to start over.

Please type your information directly into the fields of this form. If you copy text from another application or document and paste it into this Easy-Fill form and the text contains invalid (non-ASCII) characters, they will be removed from the final document.

Make sure you give yourself enough time to complete the entire form in one sitting. You will not be able to save a partially filled form to complete at a later time.

To print or order a blank form, please click here to be redirected to CSLB's "Forms and Applications" page.

9A. PERSONNEL 1

BUSINESS ENTITY

*BUSINESS NAME:

*BUSINESS WILL OPERATE AS A:

Sole Ownership
Partnership
California Corporation
Limited Liability Company

PERSONNEL FULL LEGAL NAME AND ADDRESS

If this personnel is a company, enter the company name in the first name field and enter "n/a" in fields that do not apply to companies (i.e., middle and last names, date of birth, driver license number, and Social Security number or ITIN).

*FIRST NAME: *MIDDLE NAME: Check for No Middle Name *LAST NAME: *DATE OF BIRTH: DRIVER LICENSE NUMBER: *RESIDENCE PHONE NUMBER:

*RESIDENCE ADDRESS
Non-US address? Number/Street Only - NO P.O. Boxes or PMBs: *CITY: *STATE: *ZIP CODE:

*SOCIAL SECURITY NUMBER OR ITIN: Must be hand written on form

*TITLE OR POSITION:

Owner
General Partner
Limited Partner
Responsible Managing Member
Responsible Managing Manager
Officer

* Required Entry

This is the last Personnel

9B. PERSONNEL 2

PERSONNEL FULL LEGAL NAME AND ADDRESS

*FIRST NAME: *MIDDLE NAME: Check for No Middle Name *LAST NAME: *DATE OF BIRTH: DRIVER LICENSE NUMBER: *RESIDENCE PHONE NUMBER:

*RESIDENCE ADDRESS
Non-US address? Number/Street Only - NO P.O. Boxes or PMBs: *CITY: *STATE: *ZIP CODE:

*Social Security number or ITIN: Must be hand written on form

*Title or Position:

General Partner
Limited Partner
Responsible Managing Member
Responsible Managing Manager
Officer

* Required Entry

This is the last Personnel

9C. PERSONNEL 3

PERSONNEL FULL LEGAL NAME AND ADDRESS

*FIRST NAME: *MIDDLE NAME: Check for No Middle Name *LAST NAME: *DATE OF BIRTH: DRIVER LICENSE NUMBER: *RESIDENCE PHONE NUMBER:

*RESIDENCE ADDRESS
Non-US address? Number/Street Only - NO P.O. Boxes or PMBs: *CITY: *STATE: *ZIP CODE:

*Social Security number or ITIN: Must be hand written on form

*Title or Position:

General Partner
Limited Partner
Responsible Managing Member
Responsible Managing Manager
Officer

* Required Entry

This is the last Personnel

9D. PERSONNEL 4

PERSONNEL FULL LEGAL NAME AND ADDRESS

*FIRST NAME: *MIDDLE NAME: Check for No Middle Name *LAST NAME: *DATE OF BIRTH: DRIVER LICENSE NUMBER: *RESIDENCE PHONE NUMBER:

*RESIDENCE ADDRESS
Non-US address? Number/Street Only - NO P.O. Boxes or PMBs: *CITY: *STATE: *ZIP CODE:

*Social Security number or ITIN: Must be hand written on form

*Title or Position:

General Partner
Limited Partner
Responsible Managing Member
Responsible Managing Manager
Officer

* Required Entry

Review and Edit

Please Review the Following Information

This is a summary of the information that will print on your form. If there are any corrections that need to be made, please choose the Edit button or Back button below to make the change now, as you will not have the opportunity to do so after you submit this page.

BUSINESS ENTITY

PERSONNEL 1

RESIDENCE ADDRESS

PERSONNEL 2

RESIDENCE ADDRESS

PERSONNEL 3

RESIDENCE ADDRESS

PERSONNEL 4

RESIDENCE ADDRESS

By checking this box, you understand that once you select "Next," you will no longer be able to make changes to this application.

Completion Instructions

NOTICE: This document is not submitted to or saved by CSLB. You must either print it now, save it to your computer, or email it to your email address to print and mail at a later time.

Mail your document(s) along with the application to:

Contractors State License Board
P. O. Box 26000
Sacramento, CA 95826

PDF

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Email the PDF

You can email this document to your email address. This is the same document as in the pdf view and print link above.

This process does not save or submit your document to CSLB. If you email the document to your email address, you will still need to follow the instructions to print and mail it to CSLB.

Email Address

Finished

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Section 4 - Additional Personnel

Easy-Fill Form

9A. PERSONNEL 1

BUSINESS ENTITY

PERSONNEL FULL LEGAL NAME AND ADDRESS

9B. PERSONNEL 2

PERSONNEL FULL LEGAL NAME AND ADDRESS

9C. PERSONNEL 3

PERSONNEL FULL LEGAL NAME AND ADDRESS

9D. PERSONNEL 4

PERSONNEL FULL LEGAL NAME AND ADDRESS

Review and Edit

Please Review the Following Information

RESIDENCE ADDRESS

RESIDENCE ADDRESS

RESIDENCE ADDRESS

RESIDENCE ADDRESS

Completion Instructions

PDF

Email the PDF

Finished

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