State of Maryland Department of Labor
Maryland State Board Of Plumbing
1100 N. Eutaw St
Baltimore, Maryland 21201
410-230-6164 (Baltimore area) or 1-888-218-5925 (toll free)
Plumbers - Endorsement of Employer
Plumbers - Endorsement of Employer
This blank form may be photocopied as needed for additional certificates.
It is suggested that you make and retain photocopies of the signed,
completed form(s) for your own records.
Note:
If you have not been continuously employed by the same Master Plumber, a similar form must be completed for each employer indicating hours worked.
Applicant's Full Name:
Social Security Number:
Served as a
Journey Plumber
Apprentice
FROM
TO
HOURS
Month
Day
Year
Month
Day
Year
Month
Day
Year
Month
Day
Year
Month
Day
Year
Month
Day
Year
TOTAL HOURS WORKED
Name of Master Plumber:
Company Name:
Company Address:
Street
City
State
Zip Code
I certify under penalty of perjury that the applicant named above served as a journey or apprentice plumber under my direction and supervision for the time(s) indicated.
SIGNATURE OF MASTER PLUMBER
Date Signed
Master Plumber Registration Number
State or Jurisdiction