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Fillable Concrete Safety Manager Experience Verification Form - Rev. 3/14

Fillable Concrete Safety Manager Experience Verification Form - Rev. 3/14 2025

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The document is an Experience Verification Form for applicants seeking to become Registered Concrete Safety Managers with the New York City Department of Buildings. It outlines the process for applicants to provide their employment history and requires verification from their employers regarding their experience in concrete operations. The form must be completed by an authorized employer representative, signed, notarized, and submitted to the Department of Buildings. It emphasizes the importance of truthful information and the consequences of false statements.

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