Minnesota Department of Labor and Industry Construction Codes and Licensing Division Education, Rules and Code Development

443 Lafayette Road N., St. Paul, MN 55155-4341 Phone: (651) 284-5012 Fax: (651) 284-5749 www.doli.state.mn.us TTY: (651) 297-4198

2008 Schedule Of Exam Locations and Instructions
General Information This form is to be completed and returned to the Department of Labor and Industry after all necessary prerequisites have been met. Please review the following information regarding the selection of exam locations. The Building Codes and Standards Unit will conduct examinations for the following certification categories: Certified Building Official, Certified Building Official – Limited, and Accessibility Specialist. Complete the application form on the other side. Please return the completed information as soon as possible. Applications are accepted on a first come, first served basis. The exam locations and dates provided below are subject to change if an insufficient number of applications are received. Applicants will receive written confirmation of the exact exam date and location. Written confirmations will be mailed a minimum of seven to ten days prior to the scheduled exam date. Exams start at 9:00 AM at most locations and 9:30 AM in St. Paul unless noted otherwise below. Portions of the following requested information are private. It may be released to you or State agencies pertaining to the exam and/or to verify your certification classification. Your Social Security number is requested to distinguish you from other applicants and make processing more efficient. If it is not provided, we will need to assign an individual identification number to ensure that your records will not be confused with those of other applicants. You will need to use that assigned number when contacting the Department of Labor and Industry concerning any of your records. Name, address and home phone number are required to distinguish you from other applicants, and to enable us to contact you. (M.S. 13.04 Subdivision 2)

Test Site Locations and Dates Available
St. Paul January 18 (7:00) * * March 22 May 17 July 19 August 30 October 18 November 15 Detroit Lakes February 7 April 10 June 19 August 14 October 9 December 4 Grand Rapids February 21 April 24 June 26 August 21 October 23 December 18 Mankato January 24 March 20 May 22 July 24 September 25 November 20

* * Examination during Annual Building Official Institute at the Earl Brown Continuing Education Center
EC004 09-07

Minnesota Department of Labor and Industry Construction Codes and Licensing Division Education, Rules and Code Development 443 Lafayette Road N., St. Paul, MN 55155-4341 Phone: (651) 284-5012 Fax: (651) 284-5749 www.doli.state.mn.us TTY: (651) 297-4198

Applicant information
Please print clearly
Last Name First Name MI Social Security Number -Street Address City State ZIP --

Work Phone

Home Phone

E-mail Address

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CERTIFICATION CATEGORIES FOR OFFICE USE ONLY CHECK ONLY ONE BOX CERTIFIED BUILDING OFFICIAL CERTIFIED BUILDING OFFICIAL – LIMITED ACCESSIBILITY SPECIALIST

Request For Exam Site Location
Location Date

First Choice: Second Choice: Third Choice:

__________________ __________________ __________________

__________________ __________________ __________________

EC004 09-07