How to Fill Out and Submit the LIC4: NYC Work History Form

The LIC4 is the NYC Department of Buildings work history form that applicants for a Construction Superintendent registration or a Concrete Safety Manager certification use to document their qualifying employment. You download the PDF from the DOB website, type your employment history into its five sections, sign it in front of a notary, and upload it through DOB NOW: Licensing along with a Social Security earnings record and notarized verification from each employer or from your union. Assembling the supporting paperwork takes longer than filling out the form, so start with the Social Security request months before you plan to file.

Which Credentials Use the LIC4

The form has two checkboxes at the top: Construction Superintendent and Concrete Safety Manager. Those are the only credentials the current LIC4 covers.¹ Other DOB license types — Master Plumber, Master Electrician, Site Safety Manager — have their own application checklists and experience documentation, so check the relevant license page on the DOB website if you hold one of those trades.

The form exists because NYC Administrative Code §28-401.8 requires every applicant to submit to a background investigation, and your self-reported work history is what the DOB checks against independent records.²

How to Fill Out the LIC4

Type the form. Handwritten submissions are not accepted. You can download the PDF, fill it in digitally, and print it, or print a blank copy and use a typewriter. The signature at the end must be notarized.¹

Section 1: Applicant Information

Enter your full legal name, Social Security number, date of birth, business name and address, and contact information (phone, fax, mobile, email). Check the box for the credential you are pursuing. Everything here should match your government-issued identification exactly.

Section 2: Third-Party Verification

You choose one of two verification methods. Either you commit to obtaining a notarized Employment Verification Form from each employer listed in Section 5, or you get a single notarized Employment Verification Form from your union covering your entire history. Pick one; you cannot mix the two. Union members with consistent records usually find the union route simpler because it produces one document instead of one per employer.¹

Section 4: Applicant Statements and Signatures

Sign and date the form in front of a notary. The form warns in plain language that falsifying any statement is a misdemeanor under the Administrative Code, punishable by fine, imprisonment, or both, and that offering a bribe or gratuity to a city employee in connection with your application is a crime.¹

Section 5: Relevant Employment History

This is the core of the form. Start with your most recent employer and work backward. For each position, list:

Employer’s name and full contact information (business address, phone, fax, mobile, email).
Start date and end date in month/day/year format.
Work location, filled in only if the job site was at a different address than the employer’s office.
The actual title you held, such as “Project Supervisor” or “Assistant Superintendent.”
Responsibilities described in specific terms. “Oversaw structural concrete pours for a 12-story residential building” tells the investigator more than “supervised construction.” The reviewer is looking for duties that match the qualifying experience for your credential.

The form provides space for several employers and instructs you to attach additional pages if you need more room. There is no field for a supervisor’s license number on the LIC4 itself.¹

Supporting Documents to Gather Before You File

The LIC4 alone is not enough. The background investigation cross-checks your form against outside records, and the outside records take time to obtain.

Social Security Earnings Record

The DOB uses your Social Security earnings history to confirm that employers actually reported wages for you during the periods you claim. Request it by filing Form SSA-7050-F4 (Request for Social Security Earning Information) with the Social Security Administration. Ask for the itemized statement, which lists employer names, addresses, and employment periods — not just yearly totals.³

The non-certified itemized statement costs $61. A certified version costs $96 ($61 plus a $35 certification fee). The SSA warns to allow 120 days for processing, so file this request months before your DOB application. You can pull free yearly earnings totals from ssa.gov/myaccount to spot discrepancies early, but the DOB will generally need the formal itemized version.³

If your earnings record does not match your LIC4 — for example, an employer you listed never reported wages for you — expect the DOB to flag it. Keep W-2s, pay stubs, and tax transcripts on hand for the relevant years so you can respond quickly to any questions.

Notarized Employment Verification Forms

Depending on which option you selected in Section 2, you need either one notarized Employment Verification Form per employer or a single notarized form from your union. These are separate documents from the LIC4 itself, and each must be signed before a notary. The verification confirms your job title, duties, and dates of employment.

When a Former Employer No Longer Exists

Defunct employers are one of the most common obstacles. If a company closed, was acquired, or cannot be reached, use tax records: W-2s for the years in question, IRS wage and income transcripts, or pay stubs if you kept them. If the company was acquired, the acquiring firm’s HR department may still hold historical payroll records. Union members can often use union records to cover gaps left by employers that went out of business.

Independent Contractor Experience

Work performed as an independent contractor rather than a W-2 employee will not appear on your Social Security earnings record the same way — it shows up as self-employment income. To document that work, keep copies of your Schedule C (Form 1040) filings for the relevant years and any 1099-NEC forms you received. Contracts, invoices, and project documentation help establish that the work was in the qualifying trade.

Submitting Through DOB NOW: Licensing

All new license and registration applications go through DOB NOW: Licensing at nyc.gov/dobnow. Create a DOB NOW profile first if you do not already have one.⁴

Scan your completed LIC4, notarized Employment Verification Forms, Social Security earnings record, and any other supporting documents into clear PDFs, and upload them through the portal. The system also collects the background investigation fee, which is $500 for most license types.⁵

After you submit and pay, the portal assigns a tracking number. If the investigator needs more documentation, you receive a notification through the portal. Under NYC Administrative Code §28-401.7, you must furnish all requested documents within one year of your first filing; failing to do so counts as an incomplete application and can result in denial.²

What Happens After You Submit

The DOB reviews your work history, runs the background investigation, and compares your LIC4 against your earnings record and employer verifications. If you meet all qualifications, you receive a determination email through DOB NOW with instructions for next steps, which for exam-based credentials includes scheduling the licensing exam.⁶

Once your exam application is accepted, expect an email from the exam administrator within two to three weeks with scheduling instructions. After you pass the exam and receive final approval, you have one year from the date of approval in DOB NOW to pick up your license card. Miss that window and the portal automatically closes your application as a denial, which means restarting the whole process.⁶

Mistakes That Delay Applications

Most delays trace back to the background investigation, and a few recurring problems account for most of them:

Earnings record mismatches. Your LIC4 lists an employer for 2019 to 2021, but your SSA record shows no wages from that company. This happens when an employer failed to report earnings, when you were paid off the books, or when dates are slightly off. Pull your free yearly totals from ssa.gov/myaccount before you fill out the form so you can catch problems early.
Missing verification forms. You chose employer-by-employer verification in Section 2 but only submitted forms for some of the employers listed. Every employer on the LIC4 needs a corresponding notarized verification unless you selected the union option.
Handwritten forms. The instructions require the application to be typed. Handwritten LIC4s are returned.
Vague responsibility descriptions. “General construction work” does not tell the DOB whether you supervised structural work, managed safety compliance, or swept floors. Name the type of construction, the scale of the project, and your role in specific terms.
Expired lookback periods. If your credential requires experience within a defined window before you apply, older positions do not count no matter how relevant they were. Check the lookback window for your credential before listing older jobs.

Under §28-401.6 of the Administrative Code, applicants must also be at least 18, able to read and write English, and of good moral character. The background investigation covers character fitness alongside work history, so unresolved legal issues can hold up an application independently of anything on the LIC4.²

1
NYC Department of Buildings. LIC4 Work History for Registration Application
2
NYC Administrative Code. Article 401 – General
3
Social Security Administration. Request for Social Security Earning Information
4
NYC Department of Buildings. DOB NOW Licensing
5
NYC Department of Buildings. Licensing New Examination and Background Investigation Fees
6
NYC Department of Buildings. Obtain a Master and Special Electrician License