Fillable Complete all applicable items. Type or print legibly. (North Dakota State Electrical Board)

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• Complete all applicable items. Type or print legibly.
• Appropriate application fee (check or money order) made payable to ND State Electrical Board (NDSEB) must
accompany this application.
*Note: A separate licensing fee will be required upon application approval. Journeyman applicants may submit
licensing fee of $25.00 on a separate check or money order from application fee.
• Reciprocity requirements:
o Passed written examination from the state you are reciprocating from; and
o Possess a valid license that is current, active and in good standing; and
o Held license continuously during the (1) year period prior to requesting reciprocity; and
o List experience under the supervision of a contracting master electrician in an area where electrical
construction work is done in a jurisdiction with similar licensing and inspection rules to the state of North
Dakota.
• Work experience must be completed as follows:
o Minimum of 10,000 hours for Master.
o Minimum of 8,000 hours for Journeyman.
o If self-employed need minimum hours of prior work experience.
License Type and Application Fee
☐ Master - $50.00 ☐ Journeyman - $25.00
Reciprocating State
Master & Journeyman Licenses
☐ Minnesota ☐ South Dakota
Journeyman License Only
☐ Alaska ☐ Colorado ☐ Idaho ☐ Iowa ☐ Maine ☐ Montana ☐ Nebraska ☐ New Hampshire ☐ Utah
☐ Wyoming
Name (First, Last)
Social Security Number
Date of Birth
Mailing Address
City
State
ZIP Code
Cell Phone Number
Email Address
Graduated from High School or Received a GED
☐ No ☐ Yes
Ever Been Convicted of a Felony Under the Laws of this State or Any Other Jurisdiction?
☐ No ☐ Yes - Explain fully on a separate sheet of paper
Present Employer
City
Work Experience (Commercial, Residential, Industrial, etc.)
Employment Dates
Previous Employer
City
State
Work Experience (Commercial, Residential, Industrial, etc.)
Employment Dates
APPLICATION FOR ELECTRICIAN’S LICENSE BY RECIPROCITY
NORTH DAKOTA STATE ELECTRICAL BOARD
SFN 61913 (12-2020)
SFN 61913 (12-2020)
Page 2 of 2
Previous Employer
City
Work Experience (Commercial, Residential, Industrial, etc.)
Employment Dates
Previous Employer
City
Work Experience (Commercial, Residential, Industrial, etc.)
Employment Dates
Previous Employer
City
Work Experience (Commercial, Residential, Industrial, etc.)
Employment Dates
Previous Employer
City
Work Experience (Commercial, Residential, Industrial, etc.)
Employment Dates
Attach Additional Work Experience If Needed
I authorize investigation and certify that all statements contained in this application are true and accurate. In compliance with the Federal
Privacy Act of 1974, the disclosure of the individual’s social security number on this form is mandatory pursuant to North Dakota Century
Code 43-50-02. The individual’s social security number is used for identification and verification purposes. Penalty for the applicant not
including the social security number on their application will cause the application to not be processed.
Applicant Signature
Date
Submit completed application to:
North Dakota State Electrical Board Phone: 701-328-9522
PO Box 7335 Fax: 701-328-9524
Bismarck, ND 58507 Email address: electric@nd.gov
Website: www.ndseb.com
FOR OFFICE USE ONLY
Reciprocating from State of
Date License Issued
☐ Approved ☐ Denied
For
☐ Master ☐ Journeyman
Approved By
Date
License Number
Date Issued
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Completed 21 April 2021

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