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o Minimum of 3,000 hours for Class B (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 passing the exam.
• Work experience must be completed as follows:
o Minimum of 10,000 hours for Master (one year and 2,000 hours if ND Journeyman).
o Minimum of 8,000 hours for Journeyman.
o Minimum of 3,000 hours for Class B - farmstead or residential wiring only.
o Provisional Military Spouse – experience for at least two of the four years preceding the date of
application.
o If self-employed need minimum hours of prior work experience.
o Re-exam, list your current employer, if not employed list N/A.
• Employment verification (SFN 11845) must accompany this application – not required for re-exam.
Name (First, Last)
Social Security Number
Date of Birth
Mailing Address
City
State
ZIP Code
Cell Phone Number
Email Address
Active Member of the Military
☐ No ☐ Yes
Spouse of a Member of the US Armed Forces or Reserve
☐ No ☐ Yes
Graduated from High School or Received a GED
☐ No ☐ Yes
Successfully Completed Apprenticeship Training Approved by NDSEB
☐ No ☐ Yes – Attach Completion Certificate
(Journeyman Applicants Only)
Graduate of an Electrical Trade School
☐ No ☐ Yes - Attach Transcript (Journeyman Applicants Only)
Registered or Licensed with the NDSEB
☐ No ☐ Yes
Registered or Licensed in a State Other than North Dakota
☐ No ☐ Yes - Where?
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
Work Experience (Commercial, Residential, Industrial, etc.)
Employment Dates
APPLICATION FOR ELECTRICIAN’S LICENSE BY EXAM
NORTH DAKOTA STATE ELECTRICAL BOARD
SFN 11858 (11-2020)
License Type and Application Fee
☐ Master - $50.00 ☐ Class B - $40.00 ☐ Journeyman - $25.00 ☐ Provisional - Military Spouse - $0.00
Re-Exam
☐ No ☐ Yes - Submit Application and Fee Only
SFN 11858 (11-2020)
Page 2 of 3
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
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
SFN 11858 (11-2020)
Page 3 of 3
FOR OFFICE USE ONLY
Employer
Experience Credit
Hours
Jurisdiction
Education
Hours
Completion Date
TOTAL
Re-Exam
Date
Score/Waiting Period
☐ Approved ☐ Denied
For
☐ Master ☐ Journeyman ☐ Class B ☐ Provisional – Military Spouse
Approved By
Date
Exam Date
Exam Score
License Number
Date Issued
• Each employer must verify work experience separately. Please make copies as necessary.
• Verification of hours must be on this form to be acknowledged; any other forms of verification will not be accepted.
• Employment verification must accompany the Application for Electrician’s License by Exam (SFN 11858) or Application for
Power Limited Electrician’s License (SFN 61903).
Experience Requirements:
• Master: 10,000 hours (one year and 2,000 hours if ND Journeyman).
• Class B: 3,000 hours (farmstead and residential wiring only).
• Journeyman: 8,000 hours.
• Provisional Military Spouse: Experience for at least two of the four years preceding the date of application.
• Power Limited: 6,000 hours.
Name of Applicant (First, Last)
Last 4 of Social Security Number
Address
City
State
ZIP Code
Name of Electrical Contracting/Power Limited Business
Address
City
State
ZIP Code
Master/Power Limited Name
Master/Power Limited License Number
Position Held by Applicant
Dates of Employment
Start Date: End Date:
Total Hours of Electrical/Power Limited Work
Dates Above Taken from Payroll Records
☐ Yes ☐ No - Explain
Work Completed in the State of North Dakota
☐ Yes ☐ No - Attach a List of Jobs, if Jobs were Inspected by a Governmental Authority and if a License was Required
I declare under the penalties of perjury that this employment verification is to the best of my knowledge and belief a true, correct, and
complete record.
Signature of Contracting Master/Power Limited Electrician in Presence of Notary
Date
State of
County
Before me, a notary public in and for said county/state, the NAMED PERSON below, personally appeared before me to be the same
person who executed the within and foregoing document and he/she acknowledges to me that he/she executed the same.
On this day:
Date
Name(s) of Individual Making Statement (By)
Affix Notary Stamp
Signature of Notary Public or Other Authorized Officer
Commission Expiration Date (if not listed on stamp)
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
EMPLOYMENT VERIFICATION
NORTH DAKOTA STATE ELECTRICAL BOARD
SFN 11845 (12-2020)
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o Minimum of 3,000 hours for Class B (North Dakota State Electrical Board)

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Completed 21 April 2021

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