Jackson, MO · Cape Girardeau County
Contractor License Application and Workers’ Compensation Exemption Affidavit
This form applies for a City of Jackson contractor license and lets eligible contractors attest that they are exempt from workers’ compensation coverage requirements.
- licensed online notary
- ~15 min average
- Notarized PDF emailed
What you’ll need
- Government-issued photo ID
- Webcam-enabled device (laptop or phone)
- This form, ready to upload as a PDF
What this form is
Contractors use this application to provide business and contact details when seeking a City of Jackson contractor license. Applicants must attach a workers’ compensation insurance certificate or complete the exemption waiver if they do not carry coverage; the waiver must be signed and sworn before a notary. The third page, which requests additional business information and asks about bid notices and disaster assistance, is marked optional.
Who needs it
Contractors applying for a City of Jackson license need this form and must provide proof of workers’ compensation coverage or complete the exemption affidavit.
How to get this notarized
- 1
Download the Form
Get the contractor license application and workers’ compensation exemption affidavit from the City of Jackson.
- 2
Complete the Application
Fill in the business details and either attach a workers’ compensation insurance certificate or complete the exemption waiver.
- 3
Book an Online Notary
Schedule a remote session with a commissioned online notary to notarize the exemption waiver.
- 4
Sign on Video
Sign the waiver in the notary’s presence during the video session and complete the oath.
- 5
Submit to the City
Return the completed application with payment to Jackson Public Works at the address listed on the form.
Preview the form
The blank PDF straight from Jackson. Look it over, then upload your filled copy to start the notary session.
You’ll need ID and a webcam.
A licensed online notary will join you on video, verify your government-issued ID, witness your signature, and apply their seal. You’ll receive the notarized PDF by email when the session ends.
Frequently asked questions
- How do I get the workers’ compensation exemption affidavit notarized?
- Complete the waiver section, then sign it during a video session with a commissioned online notary. The notary completes the jurat after administering the oath.
- Do I need to notarize the contractor license application?
- The application’s exemption waiver includes a “Subscribed and sworn to before me” jurat. If you use that waiver, sign before a notary; the form does not show a notary block for the insurance certificate option.
- Can I use online notarization for this form?
- Missouri authorizes remote online notarization by its own notaries under RSMo §486.1100 to §486.1205. Ask the City of Jackson whether it accepts this notarized form online; confirm with the city or town if unsure.
- Where do I submit the completed application?
- The form directs applicants to return the completed application with payment to Public Works, 2nd Floor, 101 Court Street, Jackson, MO 63755-1807.
Contractor License Application and Workers’ Compensation Exemption Affidavit in other Missouri cities
Each city publishes its own version of this form. Pick the city where you’re filing.