Use this form to apply for your personal Mold Assessor License. Note: If approved, this license is for the person listed in the ‘Applicant’s Information’ section. If you are applying for a company license please submit an Application for a Mold Assessment Contractor License, SH 125, available on our website.
You must provide personal information to complete this form. The authority to collect this information is found in the New York State (NYS) Labor Law. This information will be maintained and used to process the application you are filing with the Division of Safety and Health, License and Certificate Unit. Failure to provide this information may result in our inability to process your application.
Please see page 2 for how to submit your application, fees and required documents.