New York State Department of Labor Division of Safety and Health License and Certification Unit Stat 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Social Security Number and Last Name in the designated fields. Ensure accuracy as this information is crucial for identification.
3. Fill in your NYS Driver's License or ID Number, Home Address, Date of Birth, and contact details including phone numbers. This section helps verify your identity.
4. Indicate your employment status by selecting whether you are self-employed or working as an employee/contractor. Provide details about your employer if applicable.
5. Complete the sections regarding the purpose for which explosives will be used, related experience, and any training courses attended. Attach additional sheets if necessary.
6. Review the certification section carefully. Sign and date the application to affirm that all provided information is true.

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