DL State ____ Driver’s License # ________________
IR – Labor Standards and Enforcement
Payment Amount $ ______
www.dir.ca.gov/dlse/ecu/ElectricalTrade.html
Date of Birth (MM/DD/YYYY) ______/______/______
Electrician Certification Program
Phone (510) 286
-3900
Application for Electrician Examination and Certification
Please PRINT or TYPE all information in INK
Last Name: First Name: MI:
Name must match U. S. Drivers License or State ID:
Mailing Address:
City: ____________________________State: Zip: ____________-__________________________
Day Phone: (____)_____-_______ Email: ___________________________________________________
Note - You also need to attach the following to this application:
(a) Proof of experience as required under CCR 8, Ch. 2, Part IV, Section 291 of the regulations ‘check only one’ and
attach the Social Security Administration Employment History Report (SSN# redacted)[AB 1346]
or if coming from
another country submit verification letter(s) from employer(s):
(1) Apprenticeship Certificate (attach copy of Certificate & SSA Report (United States only). Read section (a) for
other required proof. [Regulations 291.1(a)(1) & AB 1346]
(2) On-the-job experience (enter your hours below & SSA Report) and/or Other experience, including military
(attach proof & SSA Report). Read section (a) for other required proof [Regulations 291.1(a)(2) & (c) & AB 1346]
(3) Other state license (attach copy of License & SSA Report). Read section (a) for other required proof.
[Regulations 291.1(b) & AB 1346]
(4) * Apprentice in last year of training (attach copy of DAS1 form) [Regulations 291.2(f)] *Note: No certification card
will be issued until completion of the term of apprenticeship.
(5) * Electrician Trainee has completed Approved Curriculum (attach copy of Certificate) *Note: No certification card
will be issued until the required on-the-job experience is acquired. The SSA report needs to be submitted
once you complete your experience. Read section (a) for other required proof. [Regulations 291.2(g) & AB 1346]
(6) NICET Certification in Fire Alarm Systems at Level II or above (for Fire/Life Safety Exam Only)
(attach copy of Certificate & SSA Report). Read section (a) for other required proof. [Regulations 291.1(a)(2) & AB 1346]
(a) (2) ENTER YOUR ACTUAL HOURS OF WORK HERE
But NOT more than the maximum hours for your categories listed.
USE ONLY YOUR EXAM COLUMNS
Minimum Credit Hours Required =>
General
Electrician
8,000
Residential
Electrician
4,800
Fire/Life
Safety
Tech
4,000
Voice Data
Video
Tech
4,000
Nonresidential
Lighting Tech
2,000
Stock Room and Material Handling
Max 300
Max 300
Max 300
Max 300
Max 150
Max 3,000
Max 4,800
-- n/a -- -- n/a -- -- n/a --
Max 6,000
-- n/a -- -- n/a -- -- n/a -- -- n/a --
Max 6,000
-- n/a -- -- n/a -- -- n/a -- -- n/a --
Voice Data and Video Installation
Max 1,500
Max 150
-- n/a -- -- n/a -- -- n/a --
Underground Conduit Installation
Max 750
Max 300
-- n/a -- -- n/a -- -- n/a --
Troubleshooting and Maintenance
Max 1,500
Max 600
Max 750 Max 750
-- n/a --
Max 600
Max 600
-- n/a -- -- n/a -- -- n/a --
Fire/Life Safety, Nurse Call
Max 600
-- n/a -- -- n/a -- -- n/a -- -- n/a --
-- n/a --
Max 300
-- n/a -- -- n/a -- -- n/a --
-- n/a -- -- n/a --
Max 300
-- n/a -- -- n/a --
Installations, including wire pulling,
terminations, control panels devices
-- n/a -- -- n/a --
Max 4,000 Max 4,000
-- n/a --
Proprietary systems training related to
Fire/Life Safety
-- n/a -- -- n/a --
Max 300
-- n/a -- -- n/a --
Trade specific training related to Voice,
Data, Video
-- n/a -- -- n/a -- -- n/a --
Max 300
-- n/a --
Maintenance of Lighting Fixtures
-- n/a -- -- n/a -- -- n/a -- -- n/a --
Max 1,750
Installation of Retrofit Fixtures
-- n/a -- -- n/a -- -- n/a -- -- n/a --
Max 1,500
Troubleshooting and Repairing
-- n/a -- -- n/a -- -- n/a -- -- n/a --
Max 500
Your TOTAL Credit Hours =>
(For Office Use) Tracking Nbr: Page 1 of 2 Form DLSE-ECF1 (3/2015)
