Alabama Fire Marshal's Office

*All fields are required

Renewal

Initial

Invalid Permit Number

Select Certification Class UNLIMITED GENERAL ABOVE GROUND GENERAL UNDER GROUND DEMOLITION SPECIAL *

First Name:
*

Last Name:
*

Race:
Race Caucasian African American Hispanic Asian Pacific Islander Native American Alaskan Native Other

Gender: *

Male

Female

Date of Birth:
*

Social Security Number:
* *

Phone:
* *

Email Address:
*

Renewal Email Address:
* * Renewal reminders will be sent to this address.

Mailing Address:
*

City, State, Zip:
State ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA CANADA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING * * *

Employer:
*

Employer Address:
*

City, State, Zip:
State ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA CANADA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING * * *

Employer Phone:
*

1) Have you ever been certified or licensed by this office before? *

Yes

No

2) Are you currently certifed and licensed in any other state? *

Yes

No

3) Have you ever been denied a blaster's license in any state? *

Yes

No

4) Has this blaster ever been charged with or convicted of a crime involving the illegal use of explosives? *

Yes

No

5) Are you under indictment or information for, or have you been convicted in any court of, a crime punishable by imprisonment for a term exeeding one(1) year or a felony? (Charges may include, but are not limited to, crimes involving drugs, burglary, robbery, murder, manslaughter, and explosives or firearms violations.) *

Yes

No

6) Are you a fugitive from justice? *

Yes

No

7) Are you an unlawful user or addicted to the use of alcohol, narcotics or dangerous drugs? *

Yes

No

8) Have you ever been adjudicated mentally defective or committed to a mental institution? *

Yes

No

9) Are you a United States Citizen? *

Yes

No

10) Have you been discharged from the armed forces under dishonorable conditions? *

Yes

No

11) Have you ever renounced your United States Citizenship? *

Yes

No

12) Do you store explosives? *

Always

Occasionally

Never

I hereby certify that the information provided herein is true and correct.