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    Submit Verification of Work Experience for Lead Occupation Certification

    If you would like to gain the Lead Project Designer, Lead Risk Assessor, or Lead Supervisor certification, this form is required to apply for approval with L&I's Bureau of Occupational and Industrial Safety's Certification, Accreditation & Licensing Division.

    Find form here

    Submission Requirements

    When initially applying for the Lead Project Designer, Lead Risk Assessor, or Lead Supervisor certification, you must submit a notarized copy of the Verification of Work Experience form, to be evaluated towards either your lead occupation certification application or lead exam application, to L&I's Bureau of Occupational and Industrial Safety's Certification, Accreditation & Licensing Division.

    Your work experience must reflect “from – to” dates as shown below and all experience must be listed on the form itself (no attached resumes since this is a notarized form):

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    Mail this form with the application to:

    PA Department of Labor & Industry
    Certification, Accreditation & Licensing Division
    651 Boas Street, Room 1606
    Harrisburg, PA 17121

    Contact Us

    For questions about lead certification requirements, contact L&I's Certification, Accreditation and Licensing Division.

    Call us

    You can also email the Certification, Accreditation and Licensing Division.

    Call the CAL Division

    Mail

    Mail your completed application to: PA Department of Labor & Industry Certification, Accreditation & Licensing Division 651 Boas Street, Room 1606 Harrisburg, PA 17121

    Mail

    Email Us

    If you have questions, please email the CAL Division.

    Email the CAL Division